What does Anaesthesia (01) bill under OHIP?

Anaesthesia (01) covers:

• Pre-anaesthetic evaluation
  
  The general anaesthesia service includes a pre-anaesthetic evaluation, the anaesthetic procedure itself, and post-anaesthetic follow-up.

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• Intra-operative anaesthesia service
  
  The anaesthesia fee is calculated by adding basic units + time units (and eligible extra units) and multiplying by the anaesthesiologist unit fee. The current anaesthesiologist unit fee is $15.49 per unit.

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• Post-op / ICU visits and consultations
  
  Anaesthesiologists can bill selected consultation and assessment codes (A- and C-prefix) for pre-op, post-op, or ICU work when full consultation or assessment criteria are met.

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• General definition of anaesthesia
  
  For OHIP, general anaesthesia includes all forms of anaesthesia except local infiltration unless otherwise listed.

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Which consultation codes can Anaesthesia bill?

Anaesthesiologists use standard OHIP consultation codes, plus a few anaesthesia-specific listings, when a valid request is made and all consultation elements are met.

Out-patient / office consultations (A-prefix)

• A015 – Consultation
  Standard consultation at the request of another physician or practitioner (general listing; used by Anaesthesia when criteria met).

• A016 – Repeat consultation
  Repeat consultation when the patient’s condition or diagnosis has changed sufficiently to meet repeat consultation criteria (general listing).

• A210 – Special anaesthetic consultation
  A special consultation by an anaesthesiologist with a longer, more complex assessment; start and stop times must be recorded in the patient’s permanent medical record.

• A215 – Limited consultation for acute pain management
  Limited consultation for acute pain management of a hospital in-patient, usually billed with a special visit premium; not payable with P014C, not for routine post-op pain, and not for referrals from another anaesthesiologist.

• A816 – Midwife or Aboriginal Midwife-Requested Anaesthesia Assessment (MAMRAA)
  
  Consultation-level assessment for a mother or newborn at the written request of a midwife or Aboriginal midwife due to a complex or serious problem; maximum one MAMRAA per patient per anaesthesiologist per pregnancy.

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In-patient / hospital consultations (C-prefix)

• C015 – Consultation
  In-patient consultation; same conditions as A015.

• C016 – Repeat consultation
  Repeat in-patient consultation.

• C210 – Special anaesthetic consultation
  
  In-patient version of A210, subject to the same conditions.

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• C215 – Limited consultation for acute pain management
  In-patient acute pain consultation with same conditions as A215 and billed with a C-prefix special visit premium.

• C816 – Midwife or Aboriginal Midwife-Requested Anaesthesiologist Assessment (MAMRAA)
  In-patient MAMRAA, same conditions as A816, same fee.

Key Anaesthesia consultation rules

• The pre-anaesthetic evaluation required for anaesthesia is part of the anaesthesia service and does not constitute a consultation, even if all usual assessment elements are present.

• For P014C (labour analgesia catheter), the pre-anaesthetic evaluation is included in the fee and is not payable as A215 or any other consult/assessment.

Which assessment or visit codes does Anaesthesia use?

Anaesthesiologists bill assessments when a full consultation is not required or when follow-up is needed.

Out-patient assessments (A-prefix)

• A013 – Specific assessment
  
  Problem-focused assessment in clinic or out-patient setting.

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• A014 – Partial assessment
  
  Limited assessment when only some elements are required.

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• A816 – MAMRAA
  
  Counted as an assessment-level service, with its own conditions and maximum of one per patient per anaesthesiologist per pregnancy.

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In-patient / ICU assessments (C-prefix)

• C013 – Specific assessment
  
  Used for ward/ICU assessments.

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• C014 – Specific re-assessment
  
  Shorter follow-up assessment after an initial in-patient assessment or consultation.

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• Hospital subsequent visit when surgery cancelled pre-induction
  
  If a patient is examined prior to surgery and surgery is cancelled before induction of anaesthesia, the service becomes a hospital subsequent visit, not a full anaesthesia service.

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Key assessment frequency / limitation rules

• A921/P001 example – The SoB shows patterns where services like A921/P001 block additional assessments or consults on the same day for the same physician; by analogy, be cautious about same-day overlaps.

• For MAMRAA (A816/C816), the limit is one per patient per anaesthesiologist per pregnancy.

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How do anaesthesia basic units and time units work?

How is the anaesthesia fee calculated?

The anaesthesia fee is:

(Basic units + Time units + eligible extra units) × anaesthesiologist unit fee

• Anaesthesiologist unit fee: $15.49 per unit.

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• Basic units: generally taken from the “Anae” column opposite the surgical or procedural code; for multiple procedures, use the major procedure’s Anae value.

• Time units: based on actual time in attendance in the OR.

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• For some services where no basic units are listed (IC) or for certain anaesthesia-only codes, basic units are defined in GP or specific E-/P-codes instead.

How are time units counted?

• First hour (0–60 min): 1 unit per 15 minutes

• Next 30 minutes (60–90 min): 2 units per 15 minutes

• After 1.5 hours (> 90 min): 3 units per 15 minutes

Obstetrical continuous conduction anaesthesia (epidurals)

GP95 and Obstetrical section K8 define special obstetrical anaesthesia codes:

• P013 – Obstetrical anaesthesia – 6 anaesthesia basic units.

• P014C – Labour analgesia catheter – 7 basic units.

• P016C – Maintenance of obstetrical epidural anaesthesia – 1 unit per ½ hour, max 12.

• E100C – Attendance at delivery – 4 basic units + 1 unit per ¼ hour of constant attendance (exclusive of other services except P016C).

Example – Anaesthesia for C-section

From the Obstetrics labour-delivery table:

• P018 – Caesarean section: Anae = 7 units

• P041 – C-section + tubal interruption: Anae = 7 units

• P042 – C-section + hysterectomy: Anae = 8 units

Example calculation:

• Case: C-section P018C

• Anaesthesia basic units: 7

• Anaesthesia time: 2 hours (120 minutes)

  • 0–60 min = 4 × 1 = 4 units

  • 60–90 min = 2 × 2 = 4 units

  • 90–120 min = 2 × 3 = 6 units

• Time units = 4 + 4 + 6 = 14

• Total units = 7 + 14 = 21 units

Fee = 21 × $15.49 ≈ anaesthesia fee (before premiums and extra units).

Which procedures and fee groups are most important for Anaesthesia?

Obstetrics – deliveries and obstetrical anaesthesia

Relevant codes from the Obstetrics section:

• P006 – Vaginal delivery – includes assistant and anaesthesia units (Anae 6).

• P018 / P041 / P042 – Caesarean section variants – Anae 7–8 units.

• P013 – Obstetrical anaesthesia – 6 anaesthesia units (no C suffix).

• P014C / P016C / E100C – epidural catheter, maintenance, and attendance at delivery.

Note: If the same physician claims P009 – Attendance at labour and delivery, assistant or anaesthesia units for that physician are not eligible on the same patient.

Orthopaedics – hip arthroplasty

In the Musculoskeletal “Pelvis and Hip” section (N37), the Anae column lists anaesthesia units:

• R439 – Unipolar hip arthroplasty – Anae 10 units.

• R440 – Total hip replacement – Anae 10 units.

• R631 – Hemipelvectomy – Anae 15 units.

These procedures are common for elective hip replacements and complex hip surgery, typically requiring extra units (high age, ASA status, BMI, etc.).

Endoscopy, ocular surgery, EUA, cystoscopy

• E023C – Anaesthesia for ocular surgery, cystoscopy, examination under anaesthesia

  • 6 basic units + time units.

• E032C – Anaesthesia for colonoscopy/sigmoidoscopy

  • 4 basic units + time units.

Nerve block procedures – anaesthesia support

• E030C – Procedural sedation – 4 basic units, no extra units.

• E031C – General anaesthesia or deep sedation – 4 basic units, no extra units.

Which premiums and add-ons apply to Anaesthesia?

Extra units – GP97 (high-risk / complex cases)

Examples:

• E021C – Premature newborn < 37 weeks GA – 9 units.

• E014C – Newborn 0–28 days – 5 units.

• E009C – 29 days–1 year – 4 units.

• E019C – Age 1–8 years – 2 units.

• E007C – Age 70–79 – 1 unit.

• E018C – Age ≥ 80 – 3 units.

• E010C – BMI > 40 – 2 units.

• E011C / E024C – Prone or sitting >60° – 4 units each.

• E025C – Unanticipated massive transfusion – 10 units.

• E012C – Known/suspected malignant hyperthermia – extra units as listed.

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These extras significantly increase the anaesthesia fee for high-risk, complex, paediatric, or elderly patients.

After-hours anaesthesia premiums – E400C, E401C

• E400C – Evenings/weekends

  • Case starts 17:00–24:00 Monday–Friday or any time on Saturdays, Sundays, Holidays.

  • Increases the total anaesthetic fee by 50%.

• E401C – Nights

  • Case starts 00:00–07:00.

  • Increases the total anaesthetic fee by 75%.

A replacement anaesthesiologist billing E005C can also receive E400C/E401C if the case itself commenced after hours.

Anaesthesia special visit premiums – C998C, C985C, C999C

• C998C – Evening weekday visit (17:00–24:00 or sacrifice of office hours) – $60.00.

• C985C – Weekend/holiday daytime or evening visit (07:00–24:00) – $75.00.

• C999C – Night visit (00:00–07:00) – $100.00.

After-hours procedure premiums – E409, E410, E412, E413

These are procedure premiums (not anaesthesia-unit premiums) and apply when specific criteria are met: eligible non-elective procedures, obstetrical deliveries, selected diagnostic or K-codes, and timing after hours.

• For Emergency Department physicians (H-prefix services):

  • E412 – Evenings/weekends – increases procedural fee by 20%.

  • E413 – Nights – increases procedural fee by 40%.

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• For physicians other than ED physicians (e.g., surgeons, obstetricians, or anaesthesiologists when they are the proceduralist):

  • E409 – Evenings/weekends – increases procedural fee by 50%.

  • E410 – Nights – increases procedural fee by 75%.

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In Anaesthesia (01), these are relevant mainly when the anaesthesiologist is the provider of the eligible procedure (uncommon). For routine anaesthesia services, E400C/E401C are the key after-hours premiums.

Common Anaesthesia (01) billing scenarios

Scenario 1 – Emergency C-section at night with epidural

Situation
A high-risk obstetric patient is in labour with an epidural catheter in place. At 23:30 on a weekday, the case proceeds to an emergency C-section. Anaesthesia is provided continuously by an Anaesthesia (01) specialist.

Codes to consider

• Labour epidural and obstetrical anaesthesia:

  • P014C – Introduction of catheter for labour analgesia (7 basic units).

  • P016C – Maintenance of epidural (1 unit per ½ hour, max 12).

  • P013 – Obstetrical anaesthesia (6 units) if used as the primary obstetrical anaesthesia code.

  • E100C – Attendance at delivery (4 basic units + 1 per ¼ hour).

• C-section anaesthesia units:

  • P018C / P041C / P042C – C-section variants with Anae 7–8.

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• Time units:

  • Calculated from entry into OR to completion, using the 15-minute stepped rule.

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• Extra units:

  • GP97 extra units for age, ASA status, BMI > 40, emergency, etc., as appropriate (e.g., E007C/E018C/E010C/E020C).

• After-hours anaesthesia premium:

  • E400C – Case started 23:30 (evening) → increases total anaesthetic fee by 50%.

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Why this combination is allowed

• P014C, P016C, P013 and E100C are specific obstetrical anaesthesia listings with their own unit rules.

• E400C is payable when the case commences between 17:00–24:00 and boosts the total anaesthetic fee.

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• Extra units from GP97 are restricted with P014C/P016C/E100C but can be used with other same-day C-suffix anaesthesia services.

Scenario 2 – Elective hip replacement in daytime (ASA III, age 78)

Situation
A 78-year-old ASA III patient has an elective total hip replacement (R440C). Anaesthesia time is 2 hours 20 minutes.

Codes to consider

• Base anaesthesia for hip arthroplasty:

  • R440 – Total hip replacement – Anae 10 units.

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• Time units (140 minutes):

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  • 0–60 min → 4 × 1 = 4 units

  • 60–90 min → 2 × 2 = 4 units

  • 90–140 min → 4 × 3 = 12 units

  • Total time units = 20

• Extra units:

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  • E007C – Age 70–79 → 1 extra unit

  • E022C – ASA III (if criteria met) → extra units (as per GP97 table)

Why this combination is allowed

• The SoB defines basic units using the Anae column and time units via GP93 rules.

• Extra units from GP97 are explicitly payable in addition to basic units when criteria are met (age, ASA status, etc.).

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No after-hours premium applies because the case is during daytime.

Scenario 3 – ICU high-risk patient needing Anaesthesia consult for severe pain

Situation
A hospital in-patient in ICU has severe acute pain. The intensivist requests an anaesthesiologist for acute pain management.

Codes to consider

• Initial consultation:

  • C215 – Limited consultation for acute pain management, subject to the same conditions as A215 and billed with an appropriate C-prefix special visit premium.

  • Alternatively, C015 or C210 if a full consultation is more appropriate and ≥50 minutes (for C210).

• Follow-up visits:

  • C013 – Specific assessment.

  • C014 – Specific re-assessment.

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Why this combination is allowed

• C215 is a dedicated in-patient acute pain management consultation and must follow A215 conditions (not routine post-op pain, not referral from another anaesthesiologist, not with P014C).

• C013/C014 are defined as hospital specific assessments and re-assessments for follow-up care.

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