K224 – Clinical interpretation by a geneticist requested by a midwife or aboriginal midwife
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This service is the interpretation of pertinent pedigrees (which must contain a comprehensive ancestral history), and/or cytogenetic, biochemical, or molecular genetic reports. The service must be requested in writing by a midwife or aboriginal midwife who is participating in the patient’s care and the geneticist must submit his/her findings, opinions, and recommendations in writing to both the midwife or aboriginal midwife and the patient’s primary care physician or nurse practitioner, if applicable, or the amount payable for the service will be reduced to a lesser fee.
When to Use
- Use K224 when a midwife requests a formal geneticist review of a patient's pedigree or complex molecular reports that does not involve a face-to-face consultation.
- Apply this code when interpreting cytogenetic or biochemical findings for a patient under midwifery care where the geneticist is providing an advisory opinion rather than a full clinical consultation.
Common Pitfalls
- Billing K224 on the same day as a formal consultation for the same patient will trigger an automatic rejection due to the restriction against concurrent consultation billing.
- Failure to document the distribution of the written report to both the midwife and the primary care physician will result in a payment reduction to the lesser fee.
Billing Tips
- Ensure the written request from the midwife is archived in the patient chart to satisfy the mandatory referral requirement for this specific code.
- Always confirm the primary care physician's information is included in your written report distribution to ensure full payment of the fee.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Other
Assessments
The service must be requested in writing by a midwife or aboriginal midwife who is participating in the patient’s care.
The geneticist must submit his/her findings, opinions, and recommendations in writing to both the midwife or aboriginal midwife and the patient’s primary care physician or nurse practitioner, if applicable.
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