K016 – Genetic Assessment
OHIP Consultation & Visit Premium Codes Code — Family Practice & Practice in General (00) · Schedule of Benefits
A Genetic Assessment is a time based service that requires interviewing the appropriate family members, collection and assessment of adequate clinical and genetic data to make a diagnosis, construction/revision of a pedigree, and assessment of the risk to persons seeking advice. It also includes sharing this information and any options with the appropriate family members. Time units are calculated based on the duration of direct contact between the physician and the patient or family. Unit means ½ hour or major part thereof - see General Preamble , for definitions and time-keeping requirements.
When to Use
- Use K016 when performing a comprehensive genetic risk assessment that includes pedigree construction and counseling for a patient with a suspected hereditary condition, rather than a standard A007 assessment.
- Use K016 for time-based genetic counseling sessions involving multiple family members where the focus is on interpreting genetic data and discussing inheritance patterns, provided the FCCMG designation is held.
Common Pitfalls
- Billing K016 without explicitly documenting the start and end times in the medical record will lead to automatic rejection or recovery during an audit.
- Attempting to bill K016 alongside a standard office visit code like A007 for the same encounter is considered unbundling and will result in a claim rejection.
- Claiming K016 units based on chart review or administrative time rather than direct face-to-face contact with the patient or family members violates the General Preamble definition.
Billing Tips
- Ensure the total time documented reflects only the direct interaction time; if the session lasts 40 minutes, bill one unit of K016 as it constitutes a 'major part' of the 30-minute block.
Effective: April 1, 2025
Consultations and Visits
Family Practice & Practice in General (00)
Assessment
Assessments
For services based on time, the physician must record the start and end times of the service in the patient's permanent medical record. The service is not eligible for payment without this information.
This listing may be used by specialists with FCCMG designation (Fellow of the Canadian College of Medical Geneticists).
This code is listed in the Schedule of Benefits under both 'Family Practice & Practice in General (00)' and 'Genetics (22)'.
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