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Billing Codes (Ontario OHIP)

Generate and verify codes from documentation.

Generating codes from SOAP notes

• After you have a SOAP note, open Billing → Generate Codes.
• Provide patient age, visit type (new/virtual/telephone/follow‑up), appointment length, diagnoses/impressions, and context.
• The assistant returns up to three OHIP billing codes plus 2–3 diagnostic codes with short justifications.

Premium diagnostic codes and E078A logic

• Premium 3‑digit diagnostic codes can justify E078A for chronic care management when ongoing management is indicated (e.g., ADHD).
• If a premium diagnosis applies, E078A is prioritized alongside appropriate visit codes, when compliant.

Interpreting the output and justifications

• Billing codes: Each entry includes code, brief description, and a 1–2 sentence clinical justification.
• Diagnostic codes: One primary billing diagnosis (3‑digit OHIP), plus secondary/contextual options.
• Modifiers: The tool may flag virtual or telephone modifiers and relevant counselling codes.

Common pitfalls and verification tips

• Confirm visit type and note length align with selected codes.
• Ensure chronic care qualifiers exist before using E078A.
• Only 3‑digit OHIP diagnostic codes are supported (not ICD‑10 alphanumerics).
• Always verify compliance with current OHIP guidelines before submission.