K682 – Opioid Agonist Maintenance Program monthly management fee - intensive, per month
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Monthly management of a patient in an Opioid Agonist Maintenance Program (OAMP) is the one month management and supervision of a patient receiving opioid agonist treatment by the physician most responsible for the management and supervision of that patient when rendered in accordance with the definitions and payment rules described below. The monthly management of a patient in an OAMP is only eligible for payment to a physician who has an active general exemption for methadone maintenance treatment for opioid dependence pursuant to Section 56 of the Controlled Drugs and Substances Act 1996. This service includes the following specific elements: a. All medication reviews, adjusting the dose of the opioid agonist therapy, and where appropriate, prescribing additional therapy, and discussions with pharmacists; b. With the exception of all physician to physician telephone consultation services, discussion with, and providing advice and information to the patient, patient's relative(s), patient's representative or other caregiver(s), in person, by telephone or otherwise, on matters related to the service, regardless of identity of person initiating discussion; and c. All discussions in respect of the patient's opioid dependency, except where the discussion is payable as a separate service.
When to Use
- Use K682 for patients requiring intensive management, such as those in the induction phase or those experiencing significant instability requiring frequent dose adjustments and monitoring.
- Use K682 when the patient's clinical status necessitates a higher level of oversight than the maintenance-level management provided by K683.
Common Pitfalls
- Billing K682 and K683 for the same patient in the same calendar month is a common error that will result in a rejection.
- Attempting to bill separate telephone advice codes or medication review fees for discussions regarding opioid dependency is prohibited, as these are bundled into the K682 fee.
- Failing to maintain the required Section 56 exemption status will lead to automatic recovery of all K682 payments during an audit.
Billing Tips
- Always append the K684 team premium if you meet the criteria of having at least two non-physician team members providing documented therapeutic encounters, as this is an easy way to increase monthly revenue.
- Ensure your documentation clearly justifies the 'intensive' nature of the care provided under K682 to distinguish it from the standard maintenance care of K683.
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