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K198
K198 – Psychiatric care - out-patient per unit
OHIP Consultations and Visits Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Psychiatric care 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 for an out-patient and is billed per unit. Per the note on , one unit is defined as ½ hour or a major part thereof.
In addition to the , common elements, this service includes the following specific elements:
• Performing the appropriate therapy or interaction with the patient, which may include inquiries (such as history taking and a brief physical examination) to arrive at an opinion as to the nature of the patient's condition.
• Performing any procedures during the same encounter unless the procedure is separately listed in the Schedule and payable in conjunction with the therapy.
• Making arrangements for related assessments, procedures, or therapy.
• Making arrangements for follow-up care.
• Discussing with and providing advice and information to the patient or the patient's representative.
• When medically indicated, monitoring the patient's condition and intervening until the next insured service is provided.
• Providing premises, equipment, supplies, and personnel for the specific elements.
The physician must record on the patient's permanent medical record or chart the time when the insured service started and ended.
When rendered by a Medical Trainee under supervision, the medical record must identify: the Supervising Physician; the Medical Trainee and level of training; the description of the insured service; patient consent to supervision; and evidence that the Supervising Physician has reviewed the service with the trainee. The Supervising Physician must sign off on the service or the trainee must document the discussion.
Psychiatric care performed outside a hospital, psychiatric care, primary mental health care, or hypnotherapy rendered the same day as a consultation or other assessment by the same physician to the same patient is not eligible for payment unless there are clearly defined different diagnoses for the two services.
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.
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