K122 – Subsequent visit by the Most Responsible Physician - day following the hospital admission assessment
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Developmental and/or behavioural care are services encompassing any combination or form of assessment and treatment by a paediatrician for mental illness, behavioural maladaptations, developmental disorders, and/or other problems that are assumed to be of a developmental or emotional nature where there is consideration of the patient's biological and psychosocial functioning. Unit means ½ hour or major part thereof - see General Preamble , to for definitions and time-keeping requirements.
When to Use
- Use K122 for the first subsequent visit on the day following a hospital admission assessment when providing specialized developmental or behavioural care.
- Select K122 when managing complex mental health or developmental disorders in a hospitalized pediatric patient that require at least 20 minutes of face-to-face time.
Common Pitfalls
- Billing K122 on the same day as a consultation or assessment by the same physician will result in rejection unless distinct, unrelated diagnoses are documented.
- Claiming K122 for sessions lasting less than 20 minutes is a common audit trigger; these should be billed as standard hospital visits rather than developmental care codes.
- Failing to explicitly record start and end times in the chart is a frequent cause of clawbacks, as the code is strictly time-based.
Billing Tips
- Ensure your documentation clearly reflects the developmental or psychosocial nature of the visit to justify the use of K122 over standard subsequent visit codes.
- Remember that while K122 qualifies you for the focused practice psychotherapy premium eligibility, the premium itself cannot be applied to the K122 fee.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Psychiatric Care
Psychotherapy, Psychiatric and Counselling Services
The physician must record on the patient's permanent medical record or chart the time when the insured service started and ended.
Documentation of additional residency or fellowship training must be provided if requested by the ministry.
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