OHIP Billing for Counselling Services

Content by Guest Blogger
 Judy MacAlister

Physicians doing inpatient hospital work often spend a sizable amount of time counselling relatives on inpatients. Physicians run in to a problem when they try to bill for the counselling services they provided because when you bill for any service, generally a counselling component will not be  paid if it is billed in conjunction with any other service.  However, there are some exceptions where counselling codes for time spent with relatives can be billed and paid out with other services . The exception specifically for counselling relatives in an inpatient setting is K002A (See Counselling on Pg. GP39 in SOB 2014). Although K015A is listed as an exception in the SOB as well, in my experience, whenever I have billed K015A with a procedure code, the MOH pays the lesser amount and the rejection I receive is "not permitted with services provided". So, stick with K002A!

K002A is billed for an interview with relatives or a person who is authorized to make treatment decisions.  The fee is $62.75 per 1/2 hour unit.  As the physician you are required to book the appointment, it must last at least 20 minutes and the purpose of the interview should not be solely for obtaining consent and the information obtained cannot be information that is normally obtained in the consultation or assessment of the patient. (Pg. A19 in SOB)

For example, if you are on call and you admit a patient to the ICU if you advise their relatives that you will speak with them in approximately 2 hours then you have now completed the Ministry's requirements by scheduling an appointment.  Then if the appointment lasts at least 20 minutes you can bill K002A.  You can bill this fee more than once per hospital admission if required.