K001 – Detention
OHIP Consultation & Visit Premium Codes Code — GENERAL PREAMBLE · Schedule of Benefits
Definition/Required elements of service: Detention is payable following another insured service when a physician is required to spend considerable extra time in active treatment and/or monitoring of the patient to the exclusion of all other work and in this section is based on 15-minute, or major part thereof, time units. The specific elements are those for assessments.
When to Use
- Use K001 when you must remain with a patient in an ambulance during a transfer to a hospital to provide active, continuous monitoring that precludes you from performing any other clinical work.
- Apply K001 following an urgent assessment (e.g., A007) when a patient requires prolonged stabilization or active treatment that exceeds the scope of the initial assessment time.
Common Pitfalls
- Billing K001 for administrative tasks, waiting for test results, or routine monitoring that does not require your continuous, exclusive presence is a frequent cause of rejection.
- Submitting K001 without a detailed, separate written explanation of the clinical necessity for the detention will result in an automatic rejection by the medical consultant.
- Failing to document the exact start and end times in the chart is the most common reason for audit recovery, as K001 is strictly a time-based service.
Billing Tips
- Ensure your documentation explicitly states that you were excluded from all other work during the detention period to meet the 'exclusive' requirement of the General Preamble.
- Always bill K001 in 15-minute increments, ensuring that each unit claimed represents a 'major part' (at least 8 minutes) of that 15-minute block.
Effective: April 1, 2025
GP. General Preamble
GENERAL PREAMBLE
Time-based
Assessments
Claims for detention are assessed by a medical consultant on an IC basis and require the submission of a written explanation.
As a time-based service, the physician must record on the patient's permanent medical record or chart the time when the insured service started and ended. If this information is not included, the service is not eligible for payment.
[Commentary from ]: K101 is not applicable to attendance in a vehicle other than an ambulance, in which case K001 may apply.
[Commentary from ]: Detention time may be payable following a consultation or assessment when a physician is required to spend considerable extra time in treatment or monitoring of the patient.
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