OHIP Billing: Palliative Care

The SOB defines palliative care as "care provided to a terminally ill patient in the final year of life where the decision has been made that there will be no aggressive treatment of the underlying disease and care is to be directed to maintaining the comfort of the patient until death occurs".

This blog will review billing codes commonly used for palliative care billing followed by an example.

1. Special palliative care consultation A945 ($144.75)

This is an assessment following a written request from a referring physician. A minimum of 50 minutes should be spent with the patient or their family.

2. Palliative care support K023 ($62.75 per 1/2 hour unit)

This is a time-based service for providing pain/symptom management, emotional support and counselling. This can be billed with A945 after exceeding the first 50 minutes of the consultation.

3. Counselling K015 ($62.75 per 1/2 hour unit)

This can be billed when counselling relatives on behalf of a terminally ill patient.

4. Telephone management of palliative care G511 ($17.75 per call)

This can only be billed when the phone call is requested by the patient or their caregiver, and the phone call should be documented and summarized. This cannot be billed on the same day as a consultation or assessment and can only be billed by the MRP (or substitute MRP). Max 2 times/week.

5. Palliative care case management fee G512 ($62.75)

This can be billed when providing supervision of a palliative care patient for a period of 1 week. This  includes monitoring their condition, discussion with the patient and their family, arrangements for assessments, procedures or therapy, etc. This can only be billed by the MRP and G511, K071 (acute home care supervision) and K072 (chronic home care supervision) cannot be billing during the same week as G512. In the event of a death during the week, G512 can still be billed.

6. Palliative care also has special visit and travel premiums as outlined in the SOB table below:

Palliative Care Billing Example

As the physician you just completed a house call on a palliative patient which lasted 1 hour, during the daytime on a weekday and are going to manage their palliative care for a week. You should bill the following:

A901 ($45.15) + K023 (2 units- $125.50) + B966 ($36.40) + B998 ($82.50)  + G512 ($62.75) = $352.30

where A901 is for a house call assessment that at minimum meets the requirements of an intermediate assessment.

References: http://www.health.gov.on.ca/english/providers/program/ohip/sob/physserv/sob_master11062015.pdf