Psychiatry Clarification of Virtual Care Options COVID-19

OMA sent out an email in response to the new COVID-19 temporary fee codes (K080, K081, K082, K083) outlined in Bulletin 4745 and how they apply to psychiatry.

To avoid confusion and rejections, here’s some clarification:

Which code should I use?

There’s been some uncertainty around K082 – since it’s rate is lower than the equivalent fee code K198/197.  K082 is actually meant to be used by family physicians. Instead you should use K083 for all specialist services that you would otherwise be providing in person, but are now providing via telephone/video (including K198/197).

How do I calculate the number of K083 units billed?

To calculate the number of units of K083, for whatever service you provide, round the fee to the nearest $5 and divide by 5.

For example, 1 unit of K198 psychiatric care, valued at $80.30 would be rounded down to $80, and then divided by 5, which is 16. That means you’d bill 16 units of K083.

Similarly, an A195 consultation valued at $199.40 would round to $200, then divided by 5 equaling 40. Thus, you’d bill 40 units of K083.

Just remember to continue to document as you normally would for each of the services you provide.

What does “patient initiated” mean?

The original bulletin refers to the service needing to be ‘initiated by the patient or the patient’s representative.’

This does *not* mean that all these services need to be “special visits” in accordance with the special visit premium requirements elsewhere in the schedule of benefits. The MOHLTC recognizes that patients with chronic illnesses need psychiatric care and if not they may destabilize. So, if you have patients who cannot receive in person care due to current COVID precautions and you offer them telephone/video follow up (and they agree) then that qualifies as patient initiated. 

What about supervision of residents?

Bulletin 4745 refers to services being rendered by the physician. This is just to ensure services that were not previously ‘delegatable’ to others are not now delegated using these codes (for example, to nurses or other health care professionals).

However, it doesn’t change any current teaching practices or how billing for supervision works. Therefore, if a resident provides a service that would otherwise be billable under, for example, K198, and now provides that service on the phone instead, the supervisor would bill for that service using the K083 as if they had done the K198 service.

Basically, if you can do something for the current K-code rules, you can do it under the COVID K-code rules.

What about OTN?

You can still provide care through OTN virtual care for patients. Even before the COVID-19 pandemic psychiatrists could use OTN to provide services at the same rate as the relevant OHIP specialty codes.

Whether it’s through OTN or the above virtual care codes all psychiatrists should have the ability to provide virtual care at the same rate they would normally bill the relevant OHIP service at.

What about informed patient consent, what do I tell them, and how do I document that?

The OMA communication on virtual care provides clear guidance on what patients need to be aware of, and what must be documented regarding virtual care. You’ll need to log in to find a copy of the OMA communication on virtual care.

During this time, a range of virtual platforms can be used for providing patient care, so long as adequate informed consent is obtained. Please note, for services such as group therapy, as part of informed consent you should point out to patients that the increased number of participants on group tele/video conferencing also increases the potential of a “background listener” overhearing group interactions.

If you have any questions please don’t hesitate to get in touch, we are here to help. For more on virtual care check out our Virtual Care Guide during COVID-19.

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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