OHIP Billing – A Quick Guide To Telephone Consultations, Comprehensive Consults and Detention Codes

 

OHIP Billing – A Quick Guide To Telephone Consultations, Comprehensive Consults and Detention Codes

OHIP’s provided a lot of extra fee codes in order to help compensate for all of the activities involved in managing a patient's care. Oddly enough though, we’ve noticed that most doctors aren’t billing for them. If this is you, then you might be missing out on some easy extras that can be quite lucrative over time. 

Specifically, telephone consultations, comprehensive consultations and detentions are often overlooked. To make things easier for you, we’ve compiled a quick guide for any Ontario doctor who’s looking to get paid properly for all that extra work.

Telephone Consultations

OHIP first introduced telephone codes almost 10 years ago, as a way to compensate physicians for the time they spend speaking with other physicians. Telephone codes are meant to encourage phone calls between specialities, when it isn’t always convenient, or necessary, for the patient to go see the specialist in person.

You can bill for OHIP telephone consultations if you are the referring physician (the one who is initiating the call) or if you are the consultant (the one receiving the call).

As long as your phone call takes place in Ontario, and includes at least 10 minutes of patient related discussion, both you as the referring physician, or you as the consultant, can bill for it.

Just remember that during the phone call you must record the following (in order to be able to submit a claim for it later):

  • The patient’s name.

  • Their health number.

  • The exact time when the phone call starts and when it ends.

  • The name of the Referring physician (NP or the consultant) you’re speaking with.

  • The reason for the consultation.

  • Any opinions or recommendations from the consultant (left in the notes area of the claim).

Telephone Consultations for Family Practice & Practice in General

Referring Physician
K730 - Physician to physician telephone consultation: $31.35
Daily maximum claims for an individual patient: 1

Consultant Physician

K731 - Physician to physician telephone consultation: $40.45
Daily maximum claims for an individual patient: 1

Telephone Consultations for Physicians working in an Emergency Department or an Urgent Care Clinic.

Referring Physician
K734 - Physician to physician telephone consultation: $31.35
Daily maximum claims for an individual patient: 1

Consultant Physician
K735 - Physician to physician telephone consultation: $40.45
Daily maximum claims for an individual patient: 1

Telephone Consultations Restrictions & Guidelines

Like any OHIP billing code, telephone consultations come with a list of rules and guidelines that you’re going to want to make sure you follow in order to avoid rejections. As long as you remember the following rules, you’re telephone calls will be paid in addition to any other services rendered for the patient. 

  • You can’t use phone consultations to transfer care from yourself to another doctor or vice-versa.

  • You can’t bill for them if you and the other physicians are just discussing a diagnosis, there has to be a clear recommendation or opinion from the consultant. 

  • If a phone consultation leads to an assessment or consultation by the consultant, either the same day or the following day, then the phone call is no longer billable.

CritiCall Telephone Consultation

If a phone consultation is arranged by CritiCall Ontario then different codes are used, as CritiCall telephones are still eligible for payment when discussing the management of the patient and/or the transfer of the patient to another physician (unlike regular telephone consultations).

Other than that, CritiCall telephone calls and regular telephone consultations are similar in that they pay the same amount and have the same code descriptions.

CritiCall Telephone Consultations for Family Practice & Practice in General

CritiCall Referring Physician
K732 Criticall telephone consultation: $31.35
Daily maximum claims for an individual patient: 2

CritiCall Consultant Physician
K733 Criticall telephone consultation: $40.45
Daily maximum claims for an individual patient: 3

Critical Telephone Consultations for Physicians working in an Emergency Department or an Urgent Care Clinic.

Criticall Referring Physician
K736 Criticall telephone consultation: $31.35
Daily maximum claims for an individual patient: 2

Criticall Consultant Physician
K737 Criticall telephone consultation: $40.45
Daily maximum claims for an individual patient: 3

CritiCall Telephone Consultations Restrictions & Guidelines

  • The telephone consultation service is arranged by CritiCall Ontario and subject to its requirements.

  • The referring physician and the patient are physically present in Ontario at the time of the telephone consultation.

General Overview of OHIP Telephone Consultations:

Referring Physician or GP Consultant Physician or Specialist
Phone Consult K730: $31.35 K731: $40.45
CritiCall K732: $31.35 K733: $40.45
Phone Consult – ER K734: $31.35 K735: $40.45
Criticall – ER K736: $31.35 K737: $40.45


If you find it confusing, here’s some examples directly from the Ontario Medical Association (OMA) of when telephone consults can and cannot be billed.

Example 1:

Dr. A is a family/general practitioner (FP/GP) in Ontario who has a patient with depression on medication who has deteriorated recently. The patient saw Dr. B, a psychiatrist in another Ontario city, six months ago.

Dr. A would like to consult with Dr. B to update Dr. B on the patient’s condition and ask for management advice. Dr. A speaks by telephone with Dr. B regarding the patient’s symptoms. The conversation includes the patient’s history, presenting complaints, and results of a recent laboratory test. The call lasts for 15 minutes, and Dr. B provides some advice on adjustment of medications.

Dr. A records all required information in his patient’s medical record, including Dr. B’s opinion and treatment advice, as well as the start and stop time of the call. Dr. B creates a record for the patient, and also records all required information, including the advice/ opinion given to Dr. A regarding the patient, as well as the start and stop time of the call.

What can be billed to OHIP in this scenario? As payment requirements have been met, Dr. A is eligible for payment of K730, and Dr. B is eligible for payment of K731.


Example 2:

Dr. Z is a FP/GP who has sent a patient to have a Doppler Ultrasound that day to determine if the patient has deep vein thrombosis (DVT). Dr. Z calls the radiologist (Dr. Y) after the test has been rendered, inquiring what the result of the test was.

The radiologist advises that the patient does not have DVT.

What can be billed to OHIP in this scenario? Dr. Y and Dr. Z are not eligible for payment of a telephone referral or telephone consultation as the purpose of the call was to discuss the results of the diagnostic tests.”


Example 3:

Dr. E is an emergency department physician at a community hospital who assesses an intubated comatose patient with a subarachnoid hemorrhage. The patient requires an urgent referral to a neurosurgical centre.

Dr. E contacts CritiCall Ontario and discusses the case with Dr. N, a neurosurgeon, who agrees to accept the patient in transfer. Dr. I will be managing the patient during the transfer to the neurosurgical centre and participates in the telephone consultation. Advice is provided by Dr. N about the pre-transfer and peritransfer management of the patient, and Dr. E, Dr. I and Dr. N record in their respective records details of the patient, the reason for the call, and the opinion and recommendations of the telephone consultation.

What can be billed to OHIP in this scenario? Dr. E is eligible to claim a telephone consultation as a referring physician (K732), and both Dr. I and Dr. N are eligible to claim as consultant physicians for the CritiCall Telephone Consultation (K737).

***If you aren’t sure if your telephone call is billable, don’t hesitate to contact our OHIP billing experts.


Comprehensive Consultations

Comprehensive consultations are billed when the consultation takes longer than a typical consultation. ‘Longer’ is most circumstances means a minimum of 75 minutes.

However, you cannot claim a comprehensive consultation if within the 75 minutes you spend time completing procedures or tests that are separately payable services. In saying this, the 75 minutes doesn’t have to be consecutive. Make sure you keep a track record of the start and stop times and include any notes for OHIP.

Comprehensive Consultations vary depending on your specialty, but they tend to pay much higher than a regular consultation, so if you’re doing the work - make sure you claim it! For example, for Internal Medicine, the comprehensive consultation code is A130 and pays almost twice as much as a regular consultation.


Detention Code

Remember you can always add Detention to services when there has been a considerable amount of extra time spent in active treatment, or in monitoring a patient. 

Detention (K001) is a time-based service in which 1 unit equals to 15 minutes and pays $21.10 per 1/hr. 

Detention may be payable if you spend:

  • more than 30 minutes with the patient providing a minor, partial, multiple systems or intermediate assessment or subsequent hospital visit.

  • more than 40 minutes with the patient providing a specific or general re-assessment.

  • more than 1 hour with the patient providing a consultation, repeat consultation, specific or general assessment.

  • more than 90 minutes with the patient providing a Special Palliative Care Consultation (A945, C945) or a Special Surgical Consultation (A935).



Here’s a list of activities when K001 is payable:

Activity 1:

Minor, partial, multiple systems assessment, level 1 and level 2 pediatric assessments, intermediate assessment, focused practice assessment or subsequent hospital visit.

  • Minimum time required in delivery of services before detention is payable: 30 minutes.

Activity 2:

Specific or general re-assessment.

  • Minimum time required in delivery of services before detention is payable: 40 minutes.

Activity 3:

Consultation, repeat consultation, specific or general assessment, complex dermatology assessment, complex endocrine neoplastic disease assessment, complex neuromuscular assessment, complex physiatry assessment, complex respiratory assessment, enhanced 18 month well baby visit, midwife-requested anesthesia assessment, midwife-requested assessment, midwife-requested genetic assessment or optometrist-requested assessment.

  • Minimum time required in delivery of services before detention is payable: 60 minutes.

Activity 4:

Initial assessment-substance abuse, special community medicine consultation, special family and general practice consultation, special optometrist-requested assessment, special palliative care consultation, special surgical consultation or midwife-requested special assessment.

  • Minimum time required in delivery of services before detention is payable: 90 minutes.

Detention Restrictions & Guidelines

Claims for detention are assessed by a medical consultant on an Independent Consideration basis and should be accompanied by a written explanation.

  • Detention may not be claimed for time spent waiting for an operating room, x-rays, lab reports, obstetrical deliveries, etc.

  • Detention-in-ambulance (K101, K111) pays for constant attendance and care of a patient in an ambulance.


Knowing exactly what to bill, and when you’re allowed to bill it, can be time-consuming and takes some practice. Make sure you read over your section of the schedule of benefits so you know what’s billable within your specialty.

Billing Tip: Try reviewing your billing from time to time to make sure you’re not missing out on any easy extras. If you’re submitting claims through us, write in and ask one of our billing experts.

Likewise, if you’re billing in Ontario and want to learn more about automation and how to maximize your earnings check our our free OHIP Billing guide.