Rheumatology K480 - Physician to allied professional telephone consultation

General Info

Billing Amount: $31.35

Description

This is the service where the rheumatologist participates in a telephone consultation with one or more of the following allied professionals who is funded by and affiliated with the Arthritis Society, Ontario Division: a. a physiotherapist who is a member of the College of Physiotherapists of Ontario; b. an occupational therapist who is a member of the College of Occupational Therapists of Ontario; or c. a social worker who is a member of the Ontario College of Social Workers and Social Service Workers.

Notes:

1. A maximum of one K480 service is eligible for payment per patient per day.
2. A maximum of two K480 services are eligible for payment per patient per 12 month period.
3. K480 is only eligible for payment for a physician to allied professional telephone consultation that:
a. includes a minimum of 10 minutes of patient-related discussion; and
b. where there is an established physician-patient relationship.
4. K480 is not eligible for payment to the physician in the following circumstances:
a. when the purpose of the telephone discussion is to arrange for an evaluation of the patient by the physician; or
b. in circumstances where a physician receives compensation, other than by fee-for-service under this Schedule, for participation in the telephone consultation, this service is not eligible for payment to that physician.

1. In calculating the minimum time requirement, time does not need to be continuous. In circumstances where a physician to allied health professional telephone consultation service with the consultant physician on the same day is not continuous, the total time represents the cumulative time of all telephone consultations with the same allied health professional on that day pertaining to the same patient.
2. Payment, other than by fee-for-service includes compensation where the physician receives remuneration under a salary, primary care, stipend, APP or AFP model.
3. Physicians who receive compensation other than by fee-for-service under this Schedule should consult their contract for guidance on shadow-billing.

K480 is only eligible for payment where the following elements are included in the medical record for a physician who submits a claim for the service:
1. patient’s name and health number;
2. start and stop times of the discussion;
3. name(s) of the allied professional participating in the telephone consultation;
4. reason for the consultation; and
5. the opinion and recommendations of the physician.

1. The definition/required elements of service and payment rules for consultations in the General Preamble are not applicable to physician to allied professional telephone consultations.
2. This service is eligible for payment in addition to visits or other services provided to the same patient on the same day by the same physician.

Related Specialties

Rheumatology Billing codes