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

Courtney Marie L.
July 2, 2019

Knowing which fee codes are available within your speciality 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!

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