Psychiatrists have been asking us about billing CTO’s, and wondering why the K887, K888 and K889 codes aren’t paid when submitted in the usual manner to the MOH. We have the answers below.
What are CTO’s?
Community treatment orders are billing codes that have been around for over 2 decades to allow patients with mental illnesses the opportunity to reintegrate with the community while being followed closely for their particular condition. In a lot of cases, these patients would remain hospital in-patients for the greater part of their lives, but with the regular supervision by medical staff to ensure compliance with their treatment, they can be followed on an out-patient basis.
Billing CTO claims and forms is a little more labour intensive as the requirements are somewhat different from regular OHIP claim codes. CTO claims are submitted under independent consideration, meaning they are flagged to the attention of the claims assessor and generally take longer to pay. Also, all CTO claims must be submitted with a CTO log, a form to fill out and send in with the manual review that lists all claims for a calendar month for a given patient.
How do the billing codes work?
Physicians who are MRP or who are listed in the Community Treatment Plan are eligible to bill the CTO codes. The codes are time based in ½ hour units like other psychiatry treatment codes (1/2 hour or major part thereof), and include nearly all physician services. So while we can usually bill multiple codes on the same day, with CTO’s that’s not the case. There are only a few special circumstances where other codes can be billed on the same day.
K887 ($84.70/unit) – CTO initiation – once per 6 months submit all time units
K888 ($84.70/unit) – CTO supervision – once per month submit all time units
K889 ($84.70/unit) – CTO renewal – once per 6 months submit all time units
Consultation, assessment, psychiatric care, psychotherapy, interviews, counselling, hypnotherapy, case conferences, other meetings, telephone or electronic communication with patient, family, other healthcare, social or legal workers, and time spent on CTO forms 45,46,47,48,49,50.
These are the circumstances where other codes are payable on the same date as CTO codes:
- special visits to ER or inpatient ward
- inpatient services unrelated to CTO initiation
- K623 and K624 forms
- services for unrelated diagnosis
During a CTO initiation, Dr. A spent 50 minutes (2 units) assessing and treating the patient, 22 minutes (1 unit) filling out form 46, and 30 minutes (1 unit) on the telephone with the patients family and a social worker. Total to bill = K887 x 4 units.
If you need help getting your CTO claims paid, contact JCL today!