A197 – Consultative interview on behalf of disturbed patient (including report) - consultative interview with parent(s) or patient representative(s) of patient less than age 22
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Consultative interview on behalf of disturbed patient (including report) - consultative interview with parent(s) or patient representative(s) of patient less than age 22.
When to Use
- When a psychiatrist interviews a parent or guardian about a patient under 22 who is exhibiting significant behavioral issues and cannot provide a reliable history.
- When a psychiatrist conducts a consultative interview with a patient representative to gather information for a report on a disturbed patient under 22, even if the patient is not present.
- When a psychiatrist is providing a consultative report and interview for a patient under 22 who has been referred by another physician, nurse practitioner, or dental surgeon due to a significant disturbance in their cognition, emotional regulation, or behavior.
Common Pitfalls
- Billing A197 when the primary interview was with the patient themselves; A198 is the appropriate code for direct patient interviews.
- Failing to obtain and retain a written request for consultation from the referring physician, nurse practitioner, or dental surgeon, which is a mandatory documentation requirement.
- Submitting A197 without a corresponding written report sent to the referring practitioner, as the report is an included element and a requirement for payment.
Billing Tips
- Ensure the patient is under 22 years of age and meets the 'disturbed patient' definition, meaning their condition limits their ability to provide a reliable history.
- Verify that a referral from a physician, nurse practitioner, or dental surgeon is in place, as A197 requires a referral and is not a self-referred service.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Psychiatry
Consultation
A written report (including findings, opinions, and recommendations) must be sent to the referring physician, nurse practitioner or dental surgeon.
A copy of the written request for the consultation, signed by the referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician’s medical record, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.
The request identifies the consultant by name and/or the specialty being consulted, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.
The written request sets out the information relevant to the referral and specifies the service(s) required.
The service must be personally rendered by the attending physician.
The appointment must be separately booked.
Patient less than age 22
Disturbed patient means someone experiencing a clinically significant disturbance in their cognition, emotional regulation, or behavior which limits their ability to provide a reliable and complete history.
If A197 and A198 (interview with patient < 22) are billed on the same day for the same patient, a minimum of 120 minutes of total time is required before K630 extension units become payable.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.