We often see rejections of counselling codes due to the following reasons:

  1.  Billing special visit premiums on counselling codes.
  2. Billing counselling (such as K013) on the same bill as an assessment with the same diagnosis code.

Counselling appointments are technically pre-booked and therefore no special visit premiums apply.

However, counselling codes CAN be billed on the same day as an assessment BUT:

  • They need to be on separate claims.
  • They need to have different and unrelated diagnostic codes.


***With the exception of the codes listed below, no other services are eligible for payment when rendered by the same physician the same day as any type of counselling service.

Exceptions:

E080 - First Visit by Primary Care Physician after Hospital Discharge

G010 - Laboratory medicine diagnostic & therapeutic procedures G010 - One or more parts of above without microscopy

G039 - Laboratory medicine diagnostic & therapeutic procedures G039 - Creatinine

G040 - Laboratory medicine diagnostic & therapeutic procedures G040 - Drugs of abuse screen, urine, must include testing for at least four drugs of abuse … per test

G041 - Laboratory medicine diagnostic & therapeutic procedures G041 - Target drug testing, urine, qualitative or quantitative … per test

G042 - Laboratory medicine diagnostic & therapeutic procedures G042 - Target drug testing, urine, qualitative or quantitative … per test

G043 - Laboratory medicine diagnostic & therapeutic procedures G043 - Drugs of abuse screen, urine, must include testing for at least four drugs of abuse … per test

G202 - Allergy diagnostic & therapeutic procedures - Hyposensitization - each injection

G205  - Allergy diagnostic & therapeutic procedures - Insect venom desensitization (immunotherapy) - per injection (maximum of 5 per day). in addition to g205, after the initial major assessment only, a minor or partial assessment may be claimed once per day if rendered

G365 - Gynaecology diagnostic & therapeutic procedures - Papanicolaou smear - periodic

G372 - with visit (each injection)

G384 - Injections or infusions diagnostic & therapeutic procedures. Infiltration of tissues for trigger point

G385 - Injections or infusions diagnostic & therapeutic procedures. For each additional site (to a maximum of 2) … add

G394 - Gynaecology diagnostic & therapeutic procedures G394 - Papanicolaou smear - additional

G462 - Injections or infusions diagnostic & therapeutic procedures - Administration of oral polio vaccine

G480 - Cardiovascular diagnostic & therapeutic procedures - Venipuncture - infant

G489 - Cardiovascular diagnostic & therapeutic procedures  - Venipuncture - adolescent or adult

G482 - Cardiovascular diagnostic & therapeutic procedures  - Venipuncture - child

G538 - Injections or infusions diagnostic & therapeutic procedures  - Other immunizing agents not listed above

G590 - Injections or infusions diagnostic & therapeutic procedures G590 - Influenza agent

G840 - Injections or infusions diagnostic & therapeutic procedures - Diphtheria, tetanus, and acellular pertussis vaccine/ inactivated poliovirus vaccine (dtap-ipv) - paediatric

G841 - Injections or infusions diagnostic & therapeutic procedures - Diphtheria, tetanus, acellular pertussis, inactivated polio virus, haemophilus influenza type b (dtap-ipv-hib) - paediatric

G842 - Injections or infusions diagnostic & therapeutic procedures - Hepatitis b (hb)

G843 - Injections or infusions diagnostic & therapeutic procedures - Hepatitis b (hb)

G844 - Injections or infusions diagnostic & therapeutic procedures - Meningococcal c conjugate (men-c)

G845 - Injections or infusions diagnostic & therapeutic procedures - Measles, mumps, rubella (mmr)

G846 - Injections or infusions diagnostic & therapeutic procedures - Pneumococcal conjugate

G847 - Injections or infusions diagnostic & therapeutic procedures - Diphtheria, tetanus, acellular pertussis (tdap) - adult

G848 - Injections or infusions diagnostic & therapeutic procedures - Varicella (var)

H313 - Physical medicine & rehabilitation - Rehabilitation counselling

K002 - Family practice & practice in general - Family meeting, caregiver interview

K003 - Family practice & practice in general - Interviews with children's aid society (cas) or legal guardian on be half of the patient in accordance with the health care consent act conducted for a purpose other than to obtain consent (per unit)

K008 - Family practice & practice in general - Diagnostic interview and/or counselling with child and/or parent for psychological problem or learning disabilities (per unit)
 
K014 - Family practice & practice in general - Counselling for transplant recipients, donors or families of recipients and donors

K015 - Family practice & practice in general - Counselling of relatives - on behalf of catastrophically or terminally ill patient

K031 - Family practice & practice in general - Completion of form 1 physician report in accordance with the mandatory blood testing act

K035 - Family practice & practice in general - Mandatory reporting of medical condition to the Ontario ministry of transportation

K036 - Family practice & practice in general - Completion of northern health travel grant application form

K038 - Family practice & practice in general - Completion of long-term care health report form

K682 - Family practice & practice in general - Opioid agonist maintenance program - team premium, per month, to k682 or k683

K683 - Family practice & practice in general - Opioid agonist maintenance program monthly management fee - maintenance, per month

K684 - Family practice & practice in general - Opioid agonist maintenance program - team premium, per month, to k682 or k683

K730 - Family practice & practice in general - Physician to physician telephone consultation - referring physician


If you continue to get counselling rejections, don't worry, you can easily fix them by submitting a remittance advice inquiry, however, these can sometimes take up to several months to resolve so it's best to try and prevent it from happening. Contact us if you have any questions.

 

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