K121 – Hospital in-patient case conference
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
In addition to the definitions, required elements, payment rules, medical record requirements in the Preamble - Case conferences, a hospital in-patient case conference is participation by the physician most responsible for the care of the patient and at least 2 other participants that include physicians, regulated social workers and/or regulated health professionals regarding a hospital in-patient.
When to Use
- Use K121 when coordinating complex discharge planning for an acute care patient involving at least two other regulated health professionals, such as a physiotherapist and a social worker.
- Use K121 for multidisciplinary team meetings regarding an in-patient's change in care plan that requires the presence of at least two other eligible participants, distinct from routine daily rounds.
Common Pitfalls
- Billing K121 for a discussion with only one other professional; the code strictly requires the physician plus at least two other participants.
- Failing to document the exact start and end times in the patient's chart, which is a mandatory requirement for this unit-based service and a common audit trigger.
- Attempting to bill K121 for an in-patient in a long-term care facility; K124 must be used for those settings instead.
Billing Tips
- Ensure the names and professional designations of the two required participants are clearly recorded in the progress note to substantiate the claim during a post-payment review.
- Remember that K121 is time-based and unit-defined; verify that the duration of the conference meets the minimum threshold defined in the Schedule of Benefits to avoid rejection.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Other
Hospital and Institutional Consultations and Assessments, Interviews
In addition to general medical record keeping requirements, for unit-based services, the physician must record the time when the service started and ended in the patient's permanent medical record.
The service must include participation by the physician most responsible for the care of the patient and at least 2 other participants that include physicians, regulated social workers and/or regulated health professionals.
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