K210 – Not found
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This service is for group psychotherapy provided to an in-patient as part of a 2-person group, billed per member per unit. According to the General Preamble (), psychotherapy is a form of treatment for mental illness, behavioural maladaptations, and/or other problems that are assumed to be of an emotional nature, where a physician deliberately establishes a professional relationship with a patient to alleviate symptoms, modify behaviour, and promote positive personality growth. A unit is defined as a half-hour or a major part thereof, with a minimum of 20 minutes of direct, consecutive contact time required per unit (, ).
When to Use
- Use K210 when conducting a structured psychotherapy session for exactly two in-patients simultaneously, where the therapeutic focus is on emotional or behavioral modification.
- Select K210 when the session duration is at least 20 minutes but less than 50 minutes, as it represents the base unit for group psychotherapy.
Common Pitfalls
- Billing K210 for more than two patients in a group session is an error; K211 must be used for groups of three or more.
- Failing to record exact start and end times in the chart is a frequent audit failure, as GP7 requires precise documentation for time-based psychotherapy codes.
- Attempting to bill K210 alongside a subsequent visit code (e.g., A005) for the same patient on the same day will result in a rejection due to the General Preamble restrictions.
Billing Tips
- If the session exceeds 50 minutes, bill K210 for the first unit and use K207 for each additional 30-minute unit, up to a maximum of 6 units per patient per day.
- Ensure the group size is clearly documented in the chart notes to justify the use of K210 over individual psychotherapy codes like K007 or K013.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Psychotherapy
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.
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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