Consultation
W105 Consultation
W911 Special family consultation (min. of 50 mins direct contact with patient)
W912 Comprehensive family consultation (min. of 75 mins direct contact with patient)
W106 Repeat consultation
*Please refer to the SoB page GP 17-19 for the detailed Consultation payment rules.
Long Term Care Facility: Special Visit Premium
*When billing Special Visit Premiums, use A-prefix consultation or assessment.
Premium | Weekdays Daytime (07:00- 17:00) | Weekdays Daytime (07:00 - 17:00) with Sacrifice of Office Hours | Evenings (17:00- 24:00) Monday through Friday | Sat., Sun. and Holidays (07:00- 24:00) | Nights (00:00- 07:00) |
Travel Premium | $36.40 | $36.40 | $36.40 | $36.40
W963
(max. 6 per time period) | $36.40 |
First Person Seen | $20.00 | $40.00 | $60.00 | $75.00 | $100.00 |
Additional Person(s) seen | $20.00 | $40.00 | $60.00 | $75.00 | $100.00 |
* Please refer to the SoB page GP 65-68 for the detailed Special Visit Premium payment rules.
Admission Assessment
W102 Type 1 – day of admission
W104 Type 2 – day 2 of admission
W107 Type 3 – day 3 of admission
W109 Periodic Health Visit
W777 Intermediate assessment, pronouncement of death
W771 Certification of death
W004 General re-assessment (may be claimed 6 months after W109)
W903 Pre-dental/pre-operative general assessment (maximum 2 per 12 month period)
W904 Pre-dental/pre-operative assessment
Subsequent Visits
W002 First 4 subsequent visits per patient per month
W001 Additional subsequent visits (Maximum 4 per patient per month)
W882 Palliative care
W121 Additional visits due to intercurrent illness
W010 Monthly Management (Minimum 2 assessments per patient per month)
Counselling & Interview
Automatic Codes (K01XA / K04XA)
When billing counselling codes, there are limits on the number of units billable before the need to select a different service code (refer to OHIP Schedule of Benefits section A19).
Individual Counselling (K01XA): K013 for the first three units of K013 and K040 combined per patient per provider per 12 month period; K033 thereafter.
Group Counselling (K04XA): K040 for the first three units of K013 and K040 combined per patient per provider per 12 month period; K041 thereafter.
HOW TO USE:
Simply bill K01XA (Individual Counselling) or K04XA (Group Counselling), and the system will search for existing counselling codes in our database and choose the appropriate counselling code for you.
Note:
Per unit fee calculated in ½ hour increments
With the exception of the codes listed in the below, no other services are eligible for payment when rendered by the same physician the same day as any type of counselling service: E080, G010, G039, G040, G041, G042, G043, G202, G205, G365, G372, G384, G385, G394, G462, G480, G489, G482, G538, G590, G840, G841, G842, G843, G844, G845, G846, G847, G848, H313, K002, K003, K008, K014, K015, K031, K035, K036, K038, K682, K683, K684, K730
Detention (K001) time may be payable following a consultation or assessment when a physician is required to spend considerable extra time in treatment or monitoring of the patient. See OHIP Schedule of Benefit page GP29 for further information.
K005 Primary mental health care
K014 Counselling for transplant recipients, donors or families of recipients and donors
K015 Counselling of relatives - on behalf of catastrophically or terminally ill patient
K002 Interview with relatives
Case Conference
K124 Long Term Care/CCAC case conference
K705 Long Term Care high risk patient conference
Maximum 4 services per patient per physician per 12 month period.
Maximum 8 units per patient per physician per 12 month period.
Unit calculation chart:
# Units | Minimum time |
1 unit | 10 minutes |
2 units | 16 minutes |
3 units | 26 minutes |
4 units | 36 minutes |
5 units | 46 minutes |
6 units | 56 minutes |
7 units | 66 minutes [1h 6m] |
8 units | 76 minutes [1h 16m] |
Telephone Consultations
K730 Physician to Physician telephone consultation – Referring Physician
K731 Physician to Physician telephone consultation – Consultant
* Please refer to the SoB page A40 for the detailed Telephone Consultations payment rules.