K188 – High Risk Community Psychiatric Care
OHIP Consultation & Visit Premium Codes Code — Psychiatry (19) · Schedule of Benefits
High risk community psychiatric care is a premium for a service that occurs during the six (6) month period following a suicide attempt. For the purposes of this premium, suicide attempts include self-harm attempts with intent to commit suicide or high lethality self-harm attempts, but do not include self harm attempts of low lethality with no intent to commit suicide. The premium is applicable to A190, A191, A192, A195, A197, A198, A695, A795, K195, K196, K197 and K198.
When to Use
- Use K188 when billing a psychiatric visit (e.g., A195 or K195) for a patient within six months of a high-lethality suicide attempt or self-harm with clear suicidal intent.
- Apply K188 to follow-up psychotherapy or psychiatric consultations when the patient meets the high-risk criteria, provided the service is within the six-month post-attempt window.
Common Pitfalls
- Billing K188 for low-lethality self-harm without suicidal intent will result in audit clawbacks, as this explicitly falls outside the definition.
- Attempting to bill K188 and K189 on the same day for the same patient will trigger an automatic rejection due to billing restrictions.
- Failing to track the six-month eligibility window from the date of the index suicide attempt often leads to over-billing beyond the allowed timeframe.
Billing Tips
- Ensure the base code (e.g., A195, K195) is one of the eligible codes listed in the Schedule of Benefits, as K188 is a premium and cannot be billed as a standalone service.
- When a patient is discharged from an inpatient psychiatric unit following a suicide attempt, you may stack K187 and K188 if the visit occurs within the first four weeks post-discharge and all criteria for both premiums are satisfied.
Percentage Premium: 0.15%
This code applies a percentage increase to the base procedure fee
Effective: September 1, 2011
Consultations and Visits
Psychiatry (19)
PercentageIncrease
Other Premiums (including After Hours Procedure Premiums)
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