K399 – Clinical interpretation by an immunologist
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Clinical Interpretation by an immunologist requires review of clinical data and interpretation of diagnostic tests and the results of related assessments in order to arrive at an opinion as to the nature of the patient's condition. The physician must submit his/her findings, opinions, and recommendations in writing to the patient's physician.
When to Use
- Use K399 when providing a formal written interpretation of complex immunological diagnostic tests, such as specific IgE panels or immunodeficiency workups, requested by another physician without performing a full consultation.
- Bill K399 when reviewing a patient's longitudinal immunological data to provide a written opinion on management, provided no other consultation or visit code is billed by you for that patient on the same day.
Common Pitfalls
- Billing K399 on the same day as a consultation (A005, A007, etc.) will trigger an automatic rejection as the service is considered inclusive of the consultation process.
- Failing to provide a formal written report to the referring physician is a primary audit risk, as the code specifically mandates a written submission of findings and recommendations.
Billing Tips
- Ensure your written report is dated and clearly outlines the interpretation of the diagnostic data to satisfy the documentation requirement for the Ministry of Health.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Other
Diagnostic and Therapeutic Procedures, Consultations, Assessments
The physician must submit his/her findings, opinions, and recommendations in writing to the patient's physician.
Since the Royal College of Physicians and Surgeons of Canada has not set a standard for “Allergy Specialist”, fees for consultations and visits shall be payable to an allergist according to his or her own General or Specialty listings, except as follows.
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