Billing reassessments in the ED

This article explains how to bill reassessment on your patients. What and how to bill a reassessment depends on factors like where you are working and your credentials. We will break it down by those factors.

CCFP-EM or FRCPC billing emergency codes

Both CCFP-EM and FRCPC have access to the 01882.  Just make sure you follow these rules:

  • Must be at least 2 hours after Level 2 or Consult (01810).
  • Must be at least 3 hours after Level 3
  • You can bill more than one 01882, but they must be at least 2 hours apart.
  • You cannot bill the 01882 alongside a Level 1.
  • You must include a claim note that explains medical necessity.

🤔 What does medical necessity mean?

It means must have been a change in condition or treatment plan that required a reassessment. Observation alone or for review of laboratory results/imaging does not qualify as medical necessity.

CCFP-EM or FRCPC billing GP codes (rural shifts)

You can bill the 01882 alongside GP codes as well.  Just make sure you follow these rules:

  • Must be at least 2 hours after an out-of-office visit (e.g., 13200) or out-of-office consultation (e.g., 13210)
  • You can bill more than one 01882, but they must be at least 2 hours apart.
  • You cannot bill the 01882 and out-of-office complete examination (e.g., 13201)
  • You must include a claim note that explains medical necessity.

CCFP billing GP codes (rural shifts)

FPs do not have access to the 01882, but you can bill reassessments using the 00108 or an out of office visit, depending on the time of day. See MSP's description on this:

We take this to mean that you would bill reassessments as a 00108 during weekday daytime, and as an  additional out-of-office visit during evenings, nights, and weekends. Though admittedly, the language in these notes is a bit convoluted and makes our brain hurt.