K191 – Family psychiatric care - in-patient
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Family psychiatric care is a time-based service for in-patients, defined as any combination or form of assessment and treatment by a physician for mental illness, behavioural maladaptations, and/or other problems that are assumed to be of an emotional nature, where there is consideration of the patient's biological and psychosocial functioning. The service is provided to the patient in the presence of one or more members of the patient's household or professional caregivers not on staff at the facility. Payment is calculated in units, where one unit is a half-hour or major part thereof (minimum 20 minutes for the first unit). As per , the start and end times must be recorded in the patient's medical record. This service is claimed against the patient's health number and diagnosis. For detailed conditions and time unit calculations, refer to General Preamble pages to .
When to Use
- Use K191 when conducting a family therapy session for an admitted patient that includes household members or external caregivers to address psychosocial factors.
- Choose K191 over A191 or A192 when the primary focus of the in-patient encounter is the multi-party family dynamic rather than an individual psychiatric assessment.
Common Pitfalls
- Claiming K191 on the same day as an A191 or A192 assessment by the same physician will trigger a rejection unless distinct, unrelated diagnoses are documented for each service.
- Failing to document exact start and end times in the chart is a common audit failure that leads to full recovery of the paid fee.
- Billing K191 for sessions involving only the patient and hospital staff is incorrect, as the code requires the presence of household members or non-staff professional caregivers.
Billing Tips
- Ensure the total time is calculated in 30-minute units, remembering that the first unit requires a minimum of 20 minutes to be eligible for payment.
- Always document the names and relationships of the family members or external caregivers present to satisfy the specific requirements of the K191 definition.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Other
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.
For conditions and definitions - see General Preamble to .
For electroconvulsive therapy fees, see Diagnostic and Therapeutic Procedures.
Family psychotherapy is claimed against the patient's health number and diagnosis.
Unit means ½ hour or major part thereof - see General Preamble , for definitions and time-keeping requirements.
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