K222 – Genetic care, patient or family
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Genetic care is a time based service payable for rendering a genetic assessment. Time units are calculated based on the duration of direct contact between the physician and the patient or family. Unit means ½ hour or major part thereof - see General Preamble , for definitions and time-keeping requirements.
When to Use
- Use K222 when providing genetic counseling or risk assessment to a patient or family member that does not meet the strict criteria for a formal consultation (A222) or specific visit codes.
- Apply this code for time-based genetic discussions regarding hereditary conditions, including pedigree analysis and recurrence risk counseling, when the service duration exceeds 15 minutes.
Common Pitfalls
- Billing K222 on the same day as a consultation (A222) or other assessment codes is often flagged for audit; ensure the services are distinct and time-tracked separately.
- Failing to document the exact start and end times in the chart is the most common cause for clawbacks, as K222 is strictly a time-based service under GP7.
Billing Tips
- If you are interpreting complex genetic test results alongside the K222 session, remember to bill K229 as an add-on to maximize reimbursement for the analytical portion of the visit.
- Since K222 is billed in 30-minute units (major part thereof), ensure your documentation clearly reflects at least 16 minutes of direct patient contact to justify the first unit.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments
As a time-based service, the time when the insured service started and ended must be recorded on the patient's permanent medical record or chart. See .
Payment rules: This service is limited to 4 units per patient, per day.
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