K044 – Genetic family counselling
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Genetic family counselling is counselling dedicated to an educational dialogue between the physician and one or more family members, guardians of a genetic patient or patient's representative for the purpose of providing information regarding treatment options and prognosis. The claim is submitted under the genetic patient's health number. In addition to the common elements, all Psychotherapy, Hypnotherapy, Counselling, Primary Mental Health, and Psychiatric Care include the following specific elements: A. Performing the appropriate therapy or interaction with the patient(s) or, in the case of K014, K015, and H313, the patient's relative(s) or patient's representative, which may include the appropriate inquires (including obtaining a patient history, and a brief physical examination) carried out in order to arrive at an opinion as to the nature of the patient's condition (whether such inquiry takes place before, during or after the encounter during which the therapy or other interaction takes place); any appropriate procedure(s), related service(s), and/or follow-up care. B. Performing any procedure(s) during the same encounter as the therapy or other interaction unless the procedure(s) is(are) separately listed in the Schedule and an amount is payable for the procedure in conjunction with the therapy or interaction. C. Making arrangements for any related assessments, procedures, or therapy. D. Making arrangements for follow-up care. E. Discussion with, and providing advice and information, including prescribing therapy to the patient or the patient's representative, whether by telephone or otherwise, on matters related to: a. the service; and b. in circumstances in which it would be professionally appropriate that results can be reported upon prior to any further patient visit, the results of related procedure(s) and/or assessment(s). F. When medically indicated, monitoring the condition of the patient and intervening, until the next insured service is rendered. G. Providing premises, equipment, supplies, and personnel for the specific elements of the service.
When to Use
- Use K044 when providing educational dialogue to family members regarding the prognosis and management of a patient with a confirmed or suspected genetic condition.
- Use this code when meeting with parents or guardians to discuss the implications of genetic test results, distinct from a standard office visit (A007) or general counselling (K013).
Common Pitfalls
- Submitting the claim under the family member's health number instead of the genetic patient's health number will result in an automatic rejection.
- Failing to document the exact start and end times in the patient's chart is a common audit failure that leads to full recovery of the fee.
- Billing K044 on the same day as a standard office visit (A007) for the same patient by the same physician is generally ineligible unless the services are for distinct, unrelated issues.
Billing Tips
- Ensure the documentation explicitly details the genetic nature of the discussion, as K044 is specifically reserved for genetic-related educational dialogue rather than general mental health counselling.
- Since K044 is a time-based code (units of 30 minutes), ensure the chart note clearly reflects the duration of the face-to-face interaction to justify the number of units claimed.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Other
Psychotherapy, Psychiatric and Counselling Services
The claim must be submitted under the genetic patient's health number.
For services based upon the number of 'units' of service rendered, the physician must record on the patient's permanent medical record or chart the time when the insured service started and ended. If the patient's permanent medical record or chart does not include this required information, the service is not eligible for payment.
Unit means ½ hour or major part thereof - see General Preamble , for definitions and time keeping requirements.
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