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Family Practice OHIP Billing Codes ‘Cheat Sheet’ for Physicians working in a Long Term Care Facility

Courtney Marie L.
Jul. 2, 2019
10-minute read
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Knowing which fee codes are available within your specialty is an important aspect of billing correctly. It’s not uncommon for family physicians to undercode simply because they aren’t aware of what they can use. In an attempt to make things easier, we’ve created a cheat sheet that lists all of the OHIP fee codes available for Family Physicians working in a long care facility. Remember to bookmark this page for a quick reference to Family Practice OHIP Billing Codes. For a printable PDF scroll to the bottom.  

Family Practice Guidelines for Consultations & Assessments

Consultations are allowed 1 per 12-month period.
  • Requirements: written request from a referring physician or nurse practitioner.
  • ***2nd Consultation is payable in a 12-month period if the diagnosis is completely different than the first.
Repeat Consultations are allowed 1 per 12-month period, following a consultation pertaining to the same diagnosis.
  • Requirements: written request from a referring physician or nurse practitioner.
Limited Consultations are allowed 1 per 12-month period.
  • Requirements: written request from a referring physician or nurse practitioner.
General Assessments are allowed 1 per 12-month period.
  • Requirements: less time spent with the patient than a consultation.
General Re-assessments are allowed 2 per 12-month period.
  • Partial Assessments are unlimited.
 

Family Practice OHIP Billing codes for Consultations & Assessments

W105 Consultation W911 Special family consultation
  • Minimum of 50 minutes direct contact with patient.
W912 Comprehensive family consultation
  • Minimum of 75 minutes direct contact with patient.
W106 Repeat consultation  

Long Term Care Facility: Special Visit Premium

**When using a premium for time and travel make sure the consult/assessment is the prefix A:
Weekdays Mon. - Fri. "Sacrifice of Office hours" Evenings Mon. - Fri. Weekends & Holidays Nights
Travel Premium W960 : $36.40 Max. 2 W961 : $36.40 Max. 2 W962 : $36.40 Max. 2 W963 : $36.40 Max. 6 W964 : $36.40 Unlimited
First Person Seen W990 : $20.00 Max. 1 W992 : $40.00 Max. 1 W994 : $60.00 Max. 1 W998 : $75.00 Max. 1 W996 : $100.00 Unlimited
Additonal Person(s) Seen W991: $20.00 Max. 9 W993: $40.00 Max. 9 W995: $60.00 Max. 9 W999: $75.00 Max. 19 W997: $100.00 Unlimited
 

Family Practice OHIP Billing codes for 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  

Family Practice OHIP Billing codes for Subsequent Visits

Chronic Care of Convalescent hospital

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.
 

Family Practice OHIP Billing codes for Counselling (calculated in ½ hour increments)

***if billed with a consultation/assessment or visits the diagnosis must be different for the first service.  K002  Primary mental health care K013  Individual care (first 3 units of K013, K040 combined per patient per 12 month period). K033 Additional units per patient per 12 month period  

Family Practice OHIP Billing Codes for Group Counselling

K040  2 or more persons (where no group members have received more than 3 units of any counselling per 12 month period). K041  Additional units K014  Transplant recipients, donors or families of recipients and donors. K015 Relatives of catastrophically or terminally ill patients.

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.

Case Conference Units

# 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
8 units 76 minutes

Telephone Consultations

K730  Physician to Physician telephone consultation – referring physician. K731 Physician to Physician telephone consultation – consultant.  

Common Billing Mistake: Getting rejections on Counselling Codes

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 on the same day as any type of counselling service.

Exceptions:

G480  G489  G482  G538  G590  G840  G841  G842  G843  G844  G845  G846  G847  G848  H313 K036  K038  K682  K683  K684  K730 E080 G010 G039  G040  G041  G042  G043  G202  G205  G365  G372  G384  G385  G394  G462 K002  K003  K008   K014  K015  K031  K035 

Family Practice OHIP Billing Codes ‘Cheat Sheet’

  Downloadable PDF file

If you’re interested in the most commonly used Family Practice OHIP billing codes, make sure to save a link to our OHIP searchable database below.

If you don’t see the code you’re looking for just search for it on the right hand side under “Find any billing code.”

Family Practice OHIP billing codes Searchable Database


Final Takeaway:

Remember you have the option of " starring" your most commonly used billing codes. Using this feature will help save you time as your most commonly used billing codes will appear at the top of your lists so you can find them easier.

Contact us if you have any questions regarding Family Fee Codes.

 

Looking to maximize your billing?

Check out The Ultimate OHIP Billing Guide for more tips, tricks and automated features!

 
This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBC Ventures Inc. or its affiliates.
 

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Courtney Marie L
Writer and editor with a demonstrated history of working in the Canadian healthcare sector and the publishing industry. Skilled in writing, editing, proofreading, Spanish to English translation, and teaching English as a second language. Strong communications professional with a Bachelor of Arts in Geography and Political Science from the University of Manitoba.
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