A191 – Consultative interview with caregiver(s) of a patient (65+ or dementia)
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Consultative interview on behalf of disturbed patient (including report) - consultative interview with caregiver(s) of a patient at least 65 years of age, or a patient less than 65 years of age with a diagnosis of dementia.
When to Use
- Bill A191 when a caregiver provides a history for a patient aged 65+ who is unable to give a reliable account due to cognitive decline, and a formal report is generated.
- Use A191 for interviews with caregivers of a patient under 65 with a documented dementia diagnosis who is experiencing significant behavioral disturbances, necessitating caregiver input for assessment.
- A191 is appropriate when a psychiatrist meets with the family of a 'disturbed' elderly patient to discuss management strategies and the patient's condition, provided a report is completed.
Common Pitfalls
- Billing A191 when the patient themselves is present and providing a reliable history; A192 would be more appropriate in that scenario.
- Failing to document the 'disturbed' nature of the patient, which is a key requirement for A191, leading to potential audits.
- Not including a written report with the claim; A191 explicitly requires a report as part of the service.
Billing Tips
- Ensure the minimum 60 minutes of direct contact time with the caregiver(s) is accurately recorded, as this forms the basis for billing K630 extension units.
- Remember that A191 cannot be billed on the same day as K191, K193, K195, or K196 (family psychiatric care/psychotherapy).
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Psychiatry
Consultations, Interviews
The patient must be 'disturbed', defined as experiencing a clinically significant disturbance in cognition, emotional regulation, or behavior which limits their ability to provide a reliable and complete history.
The interview must be conducted with the patient's caregiver(s).
A written report is required as part of the service.
Minimum time for the base service is 60 minutes of direct contact.
Calculation of time excludes non-patient-facing time (e.g., chart review, documentation) and time devoted to other separately billable services.
Patient is 65 years of age or older.; or Patient is under 65 years of age with a diagnosis of dementia (see Required Patient Conditions).
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.