OHIP Service Code E078 is a premium billing code(Chronic Disease – Assessment Premium) used in Ontario’s healthcare system. This code is specifically designed for eligible specialists who provide certain types of patient care. However, many physicians overlook this billing opportunity, leading to lost revenue. Understanding when and how to bill E078 ensures you maximize your eligible payments.
Who is Eligible to Bill E078?
E078 is available to specific physician specialties that provide comprehensive care in eligible scenarios. The linked service codes for these specialties are:
| Specialty | Service Code |
|---|---|
| Geriatrics | 07 |
| Endocrinology & Metabolism | 15 |
| Neurology | 18 |
| Paediatrics | 26 |
| Pathology | 28 |
| Physical Medicine | 31 |
| Therapeutic Radiology | 34 |
| Medical Oncology | 44 |
| Infectious Disease | 46 |
| Respiratory Disease | 47 |
| Rheumatology | 48 |
| Haematology | 61 |
| Clinical Immunology | 62 |
When Can You Bill E078?
E078 can be billed when a physician provides a service that qualifies under OHIP’s criteria. These often include situations where an intensive assessment, ongoing management, or critical decision-making is involved. The eligibility rules may also be tied to specific procedural or diagnostic conditions, making it important to track patient encounters correctly.
Chronic Disease Assessment Premium
The E078 Chronic Disease Assessment Premium allows for a 50% premium on fees for virtual services. However, this premium is not payable for assessments rendered to:
- In-patients of any hospital
- Patients seen in a long-term care facility
- Patients seen in an emergency department
Additionally, the patient must have an established diagnosis of a chronic disease, documented in their medical record.
Eligible Diagnostic Codes for E078
The eligibility for E078 is determined based on certain diagnostic codes that match OHIP’s billing rules. Some of the common qualifying diagnoses include:
| Diagnostic Code | Description |
|---|---|
| 042 | AIDS |
| 043 | AIDS-related complex |
| 044 | Other human immunodeficiency virus infection |
| 250 | Diabetes mellitus, including complications |
| 286 | Coagulation defects (e.g. haemophilia, other factor deficiencies) |
| 282 | Hereditary hemolytic anemia (e.g., thalassemia, sickle-cell anemia) |
| 287 | Purpura, thrombocytopenia, other haemorrhagic conditions |
| 290 | Senile dementia, presenile dementia |
| 299 | Child psychoses or autism |
| 313 | Behavioural disorders of childhood and adolescence |
| 315 | Specified delays in development (e.g. dyslexia, dyslalia, motor retardation) |
| 332 | Parkinson’s Disease |
| 340 | Multiple Sclerosis |
| 343 | Cerebral Palsy |
| 345 | Epilepsy |
| 402 | Hypertensive Heart Disease |
| 428 | Congestive Heart Failure |
| 491 | Chronic Bronchitis |
| 492 | Emphysema |
| 493 | Asthma, Allergic Bronchitis |
| 515 | Pulmonary Fibrosis |
| 555 | Regional Enteritis, Crohn’s Disease |
| 556 | Ulcerative Colitis |
| 571 | Cirrhosis of the Liver |
| 585 | Chronic Renal Failure, Uremia |
| 710 | Disseminated Lupus Erythematosus, Generalized Scleroderma, Dermatomyositis |
| 714 | Rheumatoid Arthritis, Still’s Disease |
| 720 | Ankylosing Spondylitis |
| 721 | Other seronegative spondyloarthropathies |
| 758 | Chromosomal Anomalies |
| 765 | Prematurity, low-birthweight infant |
| 902 | Educational problems |
Physicians need to refer to the most recent OHIP guidelines to ensure they are billing correctly.
How RexBill in RexEMR Ensures You Never Miss E078
With RexBill in RexEMR, you don’t have to worry about missing E078 ever again. Our automated billing system ensures that:
- System rules verify whether an encounter qualifies for E078.
- E078 is automatically added when eligible, eliminating manual tracking.
- You never underbill due to missed premium codes.
- Billing compliance is ensured, reducing errors and rejections.
One Less Thing to Worry About
With RexBill handling E078 for you, you can focus on patient care without second-guessing when to bill and when not to bill. RexEMR’s automation streamlines your billing process, improving revenue capture and minimizing administrative hassle.
