Claims Submission Ontario Health Insurance Program
Resource Manual for Physicians
 
4.13   Explanatory Codes (Continued)

Diagnostic and Therapeutic (Continued)

DL Allowed as laboratory tests in private office.
DM Paid / disallowed in accordance with MOH policy regarding an emergency department equivalent.
DN Allowed as prudenal block in addition to procedure - as per stated OHIP policy.
DP Procedure paid previously allowed at 50% in addition to this procedure - fee adjusted to pay the difference.

Fractures

F1 Additional fractures / dislocations allowed at 85%.
F2 Allowed in accordance with transferred care.
F3 Previous attempted reductions (open or closed) allowed at 85%.
F5 Two weeks aftercare included in fracture fee.
F6 Allowed as Minor / Partial Assessment.

Critical Care

G1 Other critical / comprehensive care already paid.

Hospital Visits

H2 Allowed as subsequent visit - initial visit previously claimed.
H3 Maximum fee allowed per week after 5th week.
H4 Maximum fee allowed per week after 6th week to pediatricians.
H5 Maximum fee allowed per month after the 13th week.
H6 Allowed as supportive or concurrent care.
H7 Allowed as chronic care.
H8 Hospital number and / or admission date required for in-hospital service.
H9 Concurrent care already claimed by another doctor.
HA Admission assessment claimed by another physician - hospital visit fee applied.
HF Concurrent or supportive care already claimed in period.

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