K199 – Psychiatric care - in-patient
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Psychiatric care services encompass 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 provided to an in-patient and is billed in time-based units. For in-patient psychiatric care, the time units can be calculated based on either consecutive or non-consecutive time spent rendering the service. As per , this service includes all common elements and specific elements such as performing the therapy, arranging procedures and follow-up care, discussions with the patient, and monitoring.
When to Use
- Use K199 for daily in-patient psychiatric management when the service involves ongoing assessment and treatment planning that does not meet the criteria for a formal consultation.
- Apply this code when providing psychotherapy or counselling to an admitted psychiatric patient, as it is the primary time-based unit code for in-patient psychiatric care.
Common Pitfalls
- Billing K199 on the same day as an A-code assessment (e.g., A195) by the same physician will result in rejection unless you can justify two distinct clinical encounters for different diagnoses.
- Failing to document exact start and end times in the chart is a frequent cause of clawbacks during OHIP audits, as K199 is strictly time-based.
- Attempting to bill K199 in addition to a subsequent visit code (e.g., A005) for the same patient on the same day is prohibited by the General Preamble.
Billing Tips
- Ensure your time calculation reflects the 'major part' rule, where each unit represents 30 minutes or any portion exceeding 15 minutes.
- If you provide multiple sessions throughout the day, aggregate the total time spent to bill the appropriate number of units under a single K199 entry rather than billing multiple times.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Other
Psychotherapy, Psychiatric and Counselling Services
The start and end times of the service must be recorded in the patient's permanent medical record.
For conditions and definitions - see General Preamble to .
For electroconvulsive therapy fees, see Diagnostic and Therapeutic Procedures.
When claiming group therapy only services rendered to one group are payable at the same time.
Unit means ½ hour or major part thereof - see General Preamble , for definitions and time-keeping requirements.
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