Two streams. The procedures tend to get billed because they are scheduled and documented; the consultations, assessments, conference participation and after-hours premiums are what gets lost. The two biggest recoverable items for most general surgeons are using A935A where the special surgical consultation criteria are met, and billing K708A / K709A for cancer conference participation at all.
IntelAGENT prompts the after-hours premiums from the service time and place rather than from memory the next morning. See how →
In general surgery the procedural side is self-documenting — an operation happened, there is a record, and the fee follows. Everything attached to it is where claims quietly go unbilled: the consultation that preceded it, the after-hours call-in, the tumour board on Thursday morning.
The codes and what they pay
| Code | Description | Fee |
|---|---|---|
| A935A | Special surgical consultation | $194.65 |
| A035A | Consultation | $114.75 |
| H065A | Consultation in emergency medicine | $95.60 |
| A033A | Specific assessment | $56.40 |
| K709A | Multidisciplinary cancer conference | $47.75 |
| K708A | Multidisciplinary cancer conference | $37.05 |
| H113A | After-hours premium — weekend or Friday evening | $32.20 |
| E409A | After-hours procedure premium — evenings, or daytime and evenings on weekends and holidays | add 50% |
| E410A | After-hours procedure premium — nights, 00:00h to 07:00h | add 75% |
Fees are from the OHIP Schedule of Benefits and are the ministry's, not ours. The criteria that distinguish a consultation from a special surgical consultation, the conference conditions and the premium eligibility rules are in the current Schedule — read them there before changing what you bill. These fees are from the Schedule effective July 1, 2026 (PDF).
A035A against A935A
These are the two consultation codes, and the fee difference between them is substantial. A935A is the special surgical consultation and has its own criteria; A035A is the ordinary consultation.
The problem is that A035A is never wrong in the sense that matters to the adjudicator. Billing it where A935A applied pays, so nothing rejects, nothing appears on the Remittance Advice, and the difference is invisible. Surgeons who default to A035A for everything lose a meaningful amount per year without any signal that it is happening.
The right move is not to bill A935A more aggressively, it is to know the criteria and apply them deliberately. They are in the Schedule.
Cancer conferences
K708A and K709A cover multidisciplinary cancer conference participation. Most surgeons attending a weekly tumour board are entitled to bill for some of that participation and do not, because it does not look like a billable service — there is no patient in the room and no procedure.
The conditions in the Schedule govern what qualifies, who may claim and how often. Worth reading once properly, because a weekly conference billed across a year is not a small number and the work is already being done.
The same logic applies to case conferences generally. Inpatient case conferences, discharge planning meetings and multidisciplinary rounds have codes. The common factor in all of them is that they are attended and not billed.
After-hours and call-in work
Surgical after-hours billing uses two different mechanisms, and they are easy to confuse:
- Time-of-day premiums like H113A, which attach to a service performed in a particular time band.
- Special visit premiums, which depend on your having travelled to attend specifically for that patient rather than having been present anyway.
They are not interchangeable, and claiming a special visit premium for work done during a scheduled presence is not supportable. The structure is set out in how special visit premiums work; the eligibility specifics are in the Schedule.
Get the right pair. The after-hours procedure premiums come in two rates, and which pair you are entitled to depends on who you are rather than where you are standing: E409A at add 50% and E410A at add 75% for a physician other than an emergency department physician, E412A at add 20% and E413A at add 40% for an emergency department physician. A surgeon called in to operate at 02:00h claims E410A, not E413A. Both are percentages of the procedural fee, so neither has a dollar amount you can look up.
What gets missed
-
Cancer and case conference participation
Attended weekly, billed rarely.
-
Special surgical consultations billed as ordinary consultations
Silent, because A035A pays.
-
Emergency department consultations
H065A exists for the consultation you do when the ED calls you down. It is frequently absorbed into the procedure claim or not billed at all.
-
After-hours premiums on call-in operating
The operation gets billed; the premium that reflects when you did it does not.
-
Post-operative visits outside the included period
Procedural fees include a defined post-operative period. Visits outside it, and visits for unrelated problems inside it, may be billable — the Schedule defines the boundaries.
Billing general surgery in IntelAGENT
The surgical fee is the easy part. The consultation, the assists, the premiums and the services inside a post-operative period are where the money goes missing.
- Premium prompting from time and place. Eligible after-hours premiums follow from the service date, time and facility rather than from memory at the end of a call shift.
- Referring physician validation. Consultations rejected for a bad referring provider number are one of the two main consultation rejections; the number is checked against the physician directory before submission.
- Mobile entry. Billing a call-in from the phone app at the time, which is the only reliable way to capture the premium.
- Group and departmental billing. Surgical divisions billing under a shared number get remittances split back to the rendering surgeon — groups and departments.
- Rejections with the reason attached. Claim rejections explained.
Three months free, then 0.25% of paid claims, capped at $39.99 a month. IntelAGENT has submitted OHIP claims since 2016 for more than 2,000 Ontario physicians.
Frequently asked questions
Which OHIP codes do general surgeons bill most?
The consultation codes A035A and A935A, the specific assessment A033A, emergency department consultation H065A, after-hours premiums including H113A, and the multidisciplinary cancer conference codes K708A and K709A, alongside the procedural fees for whatever was done.
What is the difference between A035A and A935A?
A035A is a consultation; A935A is a special surgical consultation, which carries a higher fee and has its own criteria in the Schedule. Billing A035A where A935A applied is a routine under-claim, since both are legitimate codes and nothing rejects.
Are multidisciplinary cancer conferences billable?
Yes. K708A and K709A cover multidisciplinary cancer conference participation, subject to the conditions in the Schedule. They are easy to leave unbilled, because the conference does not feel like a patient encounter.
How are after-hours surgical premiums billed?
Through the special visit premium mechanism and the after-hours procedure premiums, which depend on the time and the day. For a physician who is not an emergency department physician, the Schedule sets E409A at add 50% for evenings and for daytime and evenings on weekends and holidays, and E410A at add 75% for nights between 00:00h and 07:00h. E412A and E413A are the lower-rate equivalents and are payable only to emergency department physicians.