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OHIP Billing Codes for Long-Term Care Institution: Cheat Sheet

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OHIP Billing Codes for Long-Term Care Institution

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
W960
(max. 2 per
time period)

$36.40
W961
(max. 2 per
time period)

$36.40
W962
(max. 2 per
time period)

$36.40 

W963 

(max. 6 per time period)

$36.40
W964
(no max. per
time period)

First Person Seen

$20.00
W990
(max. 10
(total of first
and additional
person seen)
per time
period)

$40.00
W992
(max. 10
(total of first
and additional
person seen)
per time
period)

$60.00
W994
(max. 10
(total of first
and additional
person seen)
per time
period)

$75.00
W998
(max. 20
(total of first
and additional
person seen)
per time
period)

$100.00
W996
(no max. per
time period)

Additional Person(s) seen

$20.00
W991
(max. 10
(total of first
and additional
person seen)
per time
period)

$40.00
W993
(max. 10
(total of first
and additional
person seen)
per time
period)

$60.00
W995
(max. 10
(total of first
and additional
person seen)
per time
period)

$75.00
W999
(max. 20
(total of first
and additional
person seen)
per time
period)

$100.00
W997
(no max. per
time period)

* 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 
    1. 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.

 

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