GAP Codes
GAP codes are also intervention codes. Gap codes do not exist in the CCI because they are specific to Ontario's auto insurance health system. In some cases, GAP codes reflect administrative services and/or goods that have been provided to patients.
Coding for Assessments
Wherever possible, assessments should be coded using the GAP assessment codes. By using Gap Codes, it is possible to identify more specifically the type of assessment that is being proposed or invoiced.
Examples (NB - this is not a complete list of GAP assessment codes)
Assessment Type |
Code |
Health facility initiated Med Rehab Assessment |
HXXMR |
Health facility initiated Attendant Care Assessment |
HXXAC |
Insurer Examination – for Med Rehab |
IXXMR |
Insurer Examination – for Attendant Care |
IXXAC |
What is included in the GAP assessment codes?
The Superintendent’s Guideline (PDF) specifies on page 3 that insurers are not required to pay for administrative costs, overhead and related fees. As a result, assessment codes are inclusive of administrative activities and charges that were incurred as a result of completing the assessment. This includes contacting the patient for the purpose of booking the appointment, photocopying charges, report preparation time, etc.
Activities such as mileage, travel time or expenses related to parking should be invoiced separately.
Goods
The use of the code to specify "Other" Goods & Supplies is discouraged. If there is no code suitable to describe the good or supplies that are being provided, be sure to provide a description in the space available in each OCF form.
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