We often see rejections of counselling codes due to the following reasons:
Billing special visit premiums on counselling codes.
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.