K196 – Family psychiatric care - out-patient
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Family psychiatric care, as defined in , is a service for out-patients that encompasses 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. This service is carried out by the physician in the presence of one or more family members or in the presence of professional caregivers not on staff at the facility where the patient is receiving the care. This service is time-based, calculated in units of ½ hour (30 minutes) or major part thereof. For detailed conditions, definitions, and time-keeping requirements, see General Preamble to . In addition to the common elements, this service includes the following specific elements as per : - Performing the appropriate therapy or interaction. - Performing any procedures during the same encounter unless separately payable. - Arranging for related assessments, procedures, therapy, and follow-up care. - Discussing and providing advice/information to the patient or representative. - Monitoring the patient's condition as medically indicated. - Providing premises, equipment, and supplies for the service.
When to Use
- Use K196 when conducting family therapy sessions for a patient's mental health where at least one family member or non-staff professional caregiver is present.
- Choose K196 over K198 when the focus of the session is specifically on the family dynamic or systemic intervention rather than individual psychotherapy.
- Apply K196 when you are treating a patient's behavioural maladaptations in the presence of a guardian or family member to facilitate the patient's treatment plan.
Common Pitfalls
- Billing K196 on the same day as a consultation or assessment (A-codes) for the same patient without distinct, unrelated diagnoses will trigger an automatic rejection.
- Failing to document exact start and end times in the chart is a primary cause for clawbacks during OHIP audits, as K196 is strictly time-based.
- Claiming K196 for a session where only the patient is present; the presence of a family member or external professional caregiver is a mandatory requirement for this code.
Billing Tips
- Since K196 is billed in 30-minute units (or major part thereof), ensure your documented time clearly justifies the number of units claimed to avoid partial payment denials.
- If the patient was recently discharged from a psychiatric inpatient unit or had a recent suicide attempt, remember to append the K187 or K188 premium codes to your K196 claim to capture the 15% increase.
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 .
Unit means ½ hour or major part thereof - see General Preamble , for definitions and time-keeping requirements.
Family psychotherapy is claimed against the patient's health number and diagnosis.
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