A few years ago, OHIP introduced a series of billing codes to compensate physicians for consultations over the phone (see page A35-A40 of the Schedule of Benefits). These codes allow for the ease and convenience of a phone call where speed is required, or it isn’t convenient or easy for the patient to go see a specialist in person. Phone consults can also help family practitioners determine whether their patient needs to be assessed or followed by a particular specialty before the fact.
Referring versus Consultant Physician
There are codes available for the doctor or nurse practitioner initiating the call (the ‘referring physician’) and the doctor providing advice and consultation services (the ‘consultant physician’). The codes are K730 for the referring physician and K731 for the consultant physician, and if the doctors are in an ER setting or urgent care clinic, the codes are K734 for the referring physician and K735 for the consultant physician. There are different codes when the phone consultation is arranged by CritiCall – K732 & K733 – and over the past year, OHIP has even introduced codes for “physician to physician e-consultations”. In this post, I will discuss these codes and when to use them, and in a follow up post, I will discuss some of the problems they pose and why doctors should be careful when using them.
|Referring Physician or GP||Consultant Physician or Specialist|
|Phone consult – ER||K734||K735|
|Criticall – ER||K736||K737|
Phone consultations are to be used when one physician requests the opinion of another physician who has expertise in the area. The referring physician must transmit any relevant data to the consultant physician and must continue to care for the patient, and the phone consult will be paid in addition to any other services rendered by the referring physician.
The consultant physician has to provide an opinion and recommendations for treatment and/or management of the patient’s care after reviewing whatever documents he or she is provided. This phone call must last at least 10 minutes and take place in Ontario.
Calls initiated through Criticall Ontario are a bit different, as they allow for transfer of care as well as reaching out to specialists for treatment options. There are codes for regular criticalls and criticalls taking place in Emergency or other hospital ambulatory settings are K732, K733; and K736, K737 respectively.
Limitations and Restrictions
The key item to keep in mind, both for the referring and consultant physician, is that phone consultations are NOT TO BE USED to transfer care from one physician to another or to arrange care in any manner. They can also not be used to simply discuss diagnostic findings. If a phone consultation leads to a face to face assessment or consultation by the consultant physician either the day of or day following the phone consultation, the phone consultation is not a payable service (because OHIP will assume that the phone consult was used to arrange a face to face consultation).
To bill a phone consultation, the consultant physician must include the billing number of the referring physician and the medical notes for both physicians must include:
- The name, date of birth, and OHIP number of the patient in question
- The stop and start times of the phone call
- Names of both physicians
- Reason for the consultation
- The opinion and recommendations of the consultant physician
Our next blog goes deeper into billing telephone consults with OHIP – Read it here.