K028 – STI management
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Sexually transmitted disease (STD) or potential blood-borne pathogen management is a time based all-inclusive service for the purpose of providing assessment and counselling to a patient suspected of having a STD or to a patient with a potential blood-borne pathogen (e.g. following a "needle-stick" injury). This service is claimed in units - unit means ½ hour or major part thereof - see the General Preamble , for definitions and time keeping requirements.
When to Use
- Use K028 for the comprehensive management of a patient presenting with a suspected STI, including the time spent on contact tracing, partner notification, and extensive counselling.
- Use K028 for post-exposure prophylaxis (PEP) management following a needle-stick injury or high-risk sexual exposure, where the time spent exceeds standard assessment codes like A007.
- Use K028 when the clinical encounter focuses exclusively on the counselling and management of blood-borne pathogens, rather than a general physical examination.
Common Pitfalls
- Billing K028 on the same day as an A007 or any other assessment code will result in an automatic rejection, as K028 is all-inclusive.
- Failing to document the exact start and end times in the chart is a primary cause for clawbacks during OHIP audits, as this is a time-based code.
- Attempting to bill K028 for routine STI screening in an asymptomatic patient is inappropriate; it is intended for suspected infections or specific exposure events.
Billing Tips
- If the encounter duration is less than 15 minutes, you cannot claim a unit of K028; ensure the time spent meets the 'major part thereof' requirement of 30 minutes per unit.
- If you are the patient's primary care physician and the visit occurs within 14 days of an acute care hospital discharge, append the E080 premium to your K028 claim to maximize reimbursement.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Other
Psychotherapy, Psychiatric and Counselling Services
In calculating the time unit(s), the physician must record on the patient's permanent medical record or chart the time when the insured service started and ended.
This service is claimed in units - unit means ½ hour or major part thereof - see the General Preamble , for definitions and time keeping requirements.
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