E-consultations: K738 and K739
With wait times for specialist appointments in the high range of normal, e-consultations are rising in popularity. Family doctors in underserviced regions of Ontario are consulting specialists via email to get medical opinions quickly, determine whether patients need to see a specialist, and improve quality of care all around.
A survey recently completed by OntarioMD followed 5492 family physicians and 223 specialists over the course of a 6 month pilot program tracking the use and effects of e-consults. They found that practitioners and patients alike benefited from the e-consult program, getting important medical advice within 1-3 days instead of the weeks and months usually required for specialist opinions.
HOW TO BILL E-CONSULTS
Any physician can bill e-consults by submitting the appropriate OHIP codes with their usual monthly billing, or by using OTN (Ontario Telemedicine Network) infrastructure, and billing the OHIP code with an OTN premium. There are some important requirements, such as using a secure email account, and fulfilling the documentation requirements in the Schedule of Benefits.
Medical record requirements include noting the patient’s name, HCN, names of both physicians, reason for the consult and recommendations obtained.
The maximums for K738 and K739 are 1 per patient per day. For a given patient, only 6 services are allowed in any 12 month period. And a physician may bill only up to 400 e-consultations per any 12 month period.
K738 – E-consultation for Referring Physician – $16.00
This code is for the referring physician or nurse practitioner who requests the medical opinion of another physician (specialist) about a complex or serious case. Transmission of all relevant data, such as history and test results, is included in this service. K738 is payable with other visits or services on the same date, but is not billable when arranging for transfer of care.
K739 – E-consultation for Consultant Physician – $20.50
This code is for physicians who receive an electronic request from another physician to provide medical advice on a patient. All relevant data must be reviewed and an opinion or recommendations for treatment must be sent within 30 days of the original e-consultation request. K739 is not payable with visits, consults or assessments taking place the same day or the day after. *This code requires a referring physician or nurse practitioner.
The General Preamble of the Schedule of Benefits has provisions for e-assessments as well, with those assessments broken down into initial, repeat, follow-up and minor assessment. So far only the E-consultations have fee codes, but with digital health gaining traction, we may see more codes for electronic services in the future.