OHIP Billing for
General Surgery
The last component of a service code (an alpha character) indicates who rendered the service or
examination.
A Physician/provider who rendered the service
B Assistant who rendered the service
C Anaesthetist who rendered the service
For example:
Dr. Spriggs (OB/GYNE) is performing a caesarean section and has asked Dr. Plunkett (family physician)
to assist. Dr. Singh is the Anaesthesiologist. When each provider submits their claim for the operation,
all three will bill a P018 (for a caesarean section); however, each will complete the code with a different
suffix:
Dr. Thomas P018A (Physician/provider who rendered the service)
Dr. Plunkett P018B (Assistant who rendered the service)
Dr. Singh P018C (Anesthetist who rendered the service)
THE ASSISTANT:
The formula for the fee payable to the Assistant is calculated by adding together the number of basic and time units and
multiplying that total by the unit fee.
Basic Units +Time Units x $12.51
Where do we find the basic units?
It is found beside the surgical fee under the column “Asst” – For example, search for “Hysterectomy” in the Schedule of Benefits:
FEMALE GENITAL SURGICAL PROCEDURES
Asst Surg Anae
INCISION OR EXCISION
Hysterectomy - with or without adnexa (unless otherwise specified)
# S757 - abdominal - total or subtotal . . . . . . . . 6 463.00 7
# S816 - vaginal . . . . . . . . . . . . . . . . . . . . . . . . . 6 463.00 7
Time units are calculated for each 15 minutes or part thereof. The unit value of each 15 minute period or part thereof is:
During the first hour or less ...................................................... 1 unit
After the first hour..................................................................... 2 units
After 2.5 hours.......................................................................... 3 units
Claims submission instruction:
Submit claims for assisting at surgery using the suffix “B”, with the procedural code.
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Example:
How many “Time Units” are there in an operation that takes 1 ¾ hours?
Answer:
First hour = 4 Time Units (15 min per unit)
Plus 6 additional time Units for ¾ of the second hour (3 x 2)
Therefore, a 1 ¾ hour operation = 10 Time Units
The Complete Formula for Assisting a Surgery:
Basic Unit + Time Unit x $12.51
(Found in SOB) + (Given by Physician) x $12.51
Example:
What are the fee calculations for an Assistant billing for a hysterectomy (1 ¾ hr)
operation? (hysterectomy = S757)
Basic Unit + Time Unit x $12.51
(Found in SOB) + (Given by Physician) x $12.51
6 + 10 x $12.51
16 x $12.51
= $200.16
The Assistant Receives $200.16 (OHIP Billing Code: S757B)
The Surgeon Receives $643.35 (OHIP Billing Code: S757A)
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THE ANAESTHESIOLOGIST:
The amount payable for the anaesthesia service is calculated by adding the number of basic and time units and multiplying the
total by the anaesthesiologist unit fee.
Basic Unit + Time Unit x $15.49
(Found in SOB) + (Given by Physician) x $15.49
Basic Units: The number of basic units is the number of basic units listed opposite the service in the column headed with
“Anae” except,
a. where multiple or bilateral surgical procedures are performed during the same anaesthetic, the number of basic units
listed in the column headed with “Anae” opposite the service that describes the major procedure; or
b. where the basic units are listed as IC, or where no basic units are listed, the amount payable is calculated by adding
the appropriate time units to the basic units listed for a comparable procedure (taking into account the region, modifying
conditions, or techniques)
Time Units: Time units are calculated on the basis of time spent by the anaesthesiologist and commence when the
anaesthesiologist is first in attendance with the patient in the OR for the purpose of initiating anaesthesia and end when the
anaesthesiologist is no longer in attendance (when the patient may safely be placed under customary post-operative
supervision). Time units are calculated for each 15 minutes or part thereof. The unit value of each 15 minute period or part
thereof is:
During the first hour.................................................................. 1 unit
After the first hour up to and including the first 1.5 hours......... 2 units
After 1.5 hours.......................................................................... 3 units
Claims submission instruction:
Submit claims for anaesthesia services rendered with a surgical procedure using the suffix “C”, with the procedural code.
Example:
What are the fee calculations for an Anaesthesiologist billing for a hysterectomy (1 ¾ hr)
operation? (hysterectomy = S757)
Basic Unit + Time Unit x $15.49
(Found in SOB) + (Given by Surgeon) x $15.49
7 + 11 x $15.49
18 x $15.49
= $278.82
Try one more example:
Figure out the total fee payable to each provider below for performing the following procedure (lasting 1 hour
and 15 minutes)
- Excision (unilateral or bilateral) of the ovaries (with biopsy of ovaries by laparotomy): S780
What is the fee payable to the Surgeon? ____________
What is the fee payable to the Assistant?_____________
What is the fee payable to the Anaesthesiologist?____________
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Answers: Surgeon Fee = $257.05; Assistant Fee = (6+6)x$12.51 = 150.20; Anae Fee = (7+6)x$15.49 = $201.37
