ohip psychiatry billing

Do you see patients recently discharged from hospital?  Or treat patients following attempts at self-harm?  If so, you may be eligible for one of the following three OHIP premium codes for out-patient treatment.  These codes were introduced into the MOH’s Schedule of benefits in September of 2011 to remunerate the greater level of complexity recently discharged patients represent.

K189 ($200.00) – Urgent Community Psychiatric Follow-up
  • Bill with consultations A195, A190, A695, A795
  • K189 must take place within the 4 weeks after discharge from the hospital
  • The physician claiming the code must have had no role in patient care while the patient was admitted
  • Finally, the physician has to make a commitment to continue treatment for 6 months
K187 (15% premium) – Acute post discharge premium
  • Bill with any treatment code, such as K195, K196, K197 and K198
  • Can be billed for the first 4 weeks following discharge from hospital for a psychiatric condition
K188 (15% premium) – High risk care premium
  • Bill with any consultation, consultative interview or treatment code: A190, A195, A695, A795; A191,A192, A197, A198; K195, K196, K197, K198
  • This code can be billed anytime during the 6 months following a suicide attempt or a high-lethality attempt at self harm.  Not to be used for low-lethality self harm.

These codes cannot be billed alone; they must be billed with the appropriate treatment or consultation code in order to get paid. K188 and K187 can be billed together on treatment codes, but K189 and K188 cannot be billed on the same day.

In Practice: An Example

A patient is discharged Jan 5th from hospital.  They are referred to a psychiatrist for urgent follow-up, following a suicide attempt.

Jan 11: bill A195 ($199.40) + K189 ($200.00)

Jan 18: bill K198 x 2 units ($160.60), K187 ($24.10) and  K188 ($24.10)

Feb 2:  bill K198 x 2 units ($160.60), K187 ($24.10) and  K188 ($24.10)
– this is the last instance of K187 as the four weeks are over.

June 1: bill K198 x 1 unit ($80.30) and K188 ($12.05) for the last time, as the 6 month period is expired.

Keeping track of the time periods can be a bit tedious, but K187 is good for 1 month following discharge, and K188 for 6 months.  At JCL we keep track of these codes for our Psychiatrists, and make sure no premium is missed.  On the off chance you did miss one, you can always submit the code at a later date, as long as it is submitted within 6 months of the date of service.