K704 – Paediatric out-patient case conference
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
In addition to the definitions, required elements, payment rules, medical record requirements in the Preamble - Case conferences, a paediatric out-patient case conference is participation by the physician most responsible for the care of the patient with at least 2 other participants that include physicians, regulated social workers regulated health professionals, education professionals, and/or personnel employed by an accredited centre of Children's Mental Health Ontario, regarding an out-patient less than 18 years of age.
When to Use
- Use K704 when coordinating a complex care plan for a paediatric patient with a school psychologist and a social worker to address academic and behavioral needs.
- Use K704 when participating in a multidisciplinary team meeting involving a speech-language pathologist and a paediatrician to manage a patient with complex developmental delays.
- Use K704 when collaborating with a Children's Mental Health Ontario centre representative and a school guidance counsellor to stabilize a patient's mental health treatment plan.
Common Pitfalls
- Billing K704 when the physician is not a specialist in Paediatrics (26) or Psychiatry (19), as the code is restricted to these specialties as the lead participant.
- Attempting to bill K704 on the same day as a K005 or K007 telephone consultation, which will result in an automatic rejection due to same-day service restrictions.
- Failing to document the specific start and stop times, which is a mandatory requirement for audit compliance under the Preamble.
Billing Tips
- Ensure the documentation explicitly lists the names and professional designations of the two required participants to avoid rejection during manual review.
- If the patient is admitted to an acute care hospital, switch to K121 instead of K704, as K704 is strictly for out-patient care.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Other
Assessments
identification of the patient;
start and stop time of the discussion regarding the patient;
identification of the eligible participants, and
the outcome or decision of the case conference.
out-patient less than 18 years of age
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