This article was originally published on August 24, 2019 and has since been updated.
Did you know?
Doctor-to-doctor telephone consultations as short as 10 minutes in duration are eligible for payment by OHIP.
At Dr. Bill, we’ve noticed that telephone consultations are one of those tasks many doctors regularly perform—yet also regularly leave unclaimed!
Everyone wins when physicians collaborate on patient care. That’s why the valuable time you spend obtaining and/or providing telephone consultations is billable.
In this article, we’ll cover:
- Who can bill for telephone consultations in Ontario
- OHIP billing codes for telephone consultations
- When telephone consultation K-codes do not apply
- CritiCall billing codes and guidelines
- OHIP billing codes for e-consults
- Download our Virtual Care Guide
Who can bill for telephone consultations in Ontario?
Both the referring physician (the doctor who initiates a call) and the consultant physician (the doctor who receives the call) can bill OHIP for telephone consults.
For the most part, as long as your phone call takes place in Ontario, and includes at least 10 minutes of patient-related discussion resulting in a clear recommendation, the consultation qualifies to be claimed by both physicians.
Though nurse practitioners don’t bill OHIP directly, they can also initiate telephone and e-consultations in Ontario (functioning as the referring physician).
OHIP billing codes for telephone consultations:
Apply the appropriate fee code from the following list when claiming a telephone consultation:
|
Referring Physician |
Consulting Physician |
|||
| Fee Code | Value | Fee Code | Value | |
| Phone Consult | K730 | $31.35 | K731 | $40.45 |
| Phone Consult (ER or Urgent Care) |
K734 | $31.35 | K735 | $40.45 |
You can claim the relevant K-code a maximum of once per patient per day and each claim must include the following:
- Patient name
- Health card number
- Phone call start and end times
- Name of the referring or consultant physician or NP
- Reason for consult
- Opinions or recommendations from the consultant (in the notes field)
When telephone consultation K-codes DO NOT apply
OHIP telephone consult K-codes are not billable in the following scenarios:
- When transferring care from one doctor to another
- When just discussing a diagnosis (a clear recommendation or opinion from the consultant must result from the call)
- When the phone consultation leads to a direct patient consultation or assessment by the consultant physician either the same or next day
For more information on the parameters for telephone consultation claims, see the Ministry of Health Schedule of Benefits and Fees.
CritiCall billing codes and guidelines
CritiCall Ontario is a 24/7 emergency consultation and referral service for physicians in hospital settings in Ontario. Physicians can work with CritiCall to connect with a wide range of specialists quickly. OHIP can then be billed directly for eligible consultations.
Apply the appropriate fee code when claiming a telephone consultation arranged by CritiCall:
|
CritiCall Referring Physician
|
CritiCall Consultant Physician
|
|||
| Fee Code | Value | Fee Code | Value | |
| Phone Consult | K732 | $31.35 | K733 | $40.45 |
| Phone Consult (ER or Urgent Care) |
K736 | $31.35 | K737 | $40.45 |
You can claim the relevant CritiCall fee code a maximum of twice per patient per day as the referring physician and three times per patient per day as the consultant physician.
A notable difference between CritiCall consults and regular telephone consults is that CritiCall consult fee codes can be claimed when transferring care from one doctor to another. Consult the Ministry of Health Schedule of Benefits and Fees for full CritiCall claim guidelines.
- K738 and K739 are each limited to a maximum of one (1) service per patient per day.
- K738 and K739 are each limited to a maximum of six (6) services per patient, any physician, per 12 month period.
- K738 and K739 can each be billed a maximum of 400 times per physician per 12 month period.
OHIP billing codes for e-consults
E-consultations can help physicians get a specialist opinion quickly (often within days) when a referral might take weeks or months.
To be eligible for payment, e-consultation claims must follow certain guidelines, including the use of a secure platform to ensure patient privacy.
Apply the appropriate fee code when billing for e-consults:
|
Referring Physician
|
Consultant Physician
|
|||
| Fee Code | Value | Fee Code | Value | |
| E-Consult | K738 | $16.00 | K739 | $20.50 |
K738 and K739 are each limited to 1 service per patient per day and a maximum of 6 services per patient (any physician) per 12-month period.
The Ontario Medical Association has published a Quick Reference Guide to aid physicians in engaging in e-consultations and applying e-consultation codes correctly.
Download our Virtual Care Guide
Beyond doctor-to-doctor consultations, physicians also provide a wealth of direct patient services through telephone and video. Browse our Virtual Care Guide for more information on COVID-19 Virtual Care K-Codes, booking virtual appointments and virtual care etiquette.
Have a specific question about billing for telephone consultations or virtual care? Contact us at Dr. Bill and one of our OHIP Billing Specialists will be happy to help.
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