K735 – Physician to physician telephone consultation - Consultant physician
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Physician to physician telephone consultation is a service where the referring physician or nurse practitioner, in light of his/her professional knowledge of the patient, requests the opinion of a physician (the “consultant physician") by telephone who is competent to give advice in the particular field because of the complexity, seriousness, or obscurity of the case. This service is only eligible for payment if the consultant physician has provided an opinion and/or recommendations for patient treatment and/or management. For the purpose of this service, “relevant data” include family/patient history, history of the presenting complaint, laboratory and diagnostic tests, where indicated and feasible in the circumstances. Definition/Required elements of service – Consultant physician This service includes all services rendered by the consultant physician to provide opinion/advice/recommendations on patient care, treatment and management to the referring physician. The consultant physician is required to review all relevant data provided by the referring physician or nurse practitioner. K735 applies when the service is rendered by a physician on duty in an emergency department or a hospital urgent care clinic.
When to Use
- Use K735 when you are the consultant physician working in an emergency department or hospital urgent care clinic and provide clinical advice to a referring physician regarding a patient's management.
- Use K735 specifically when the consultation occurs via telephone, distinguishing it from K730 or K731 which are intended for non-emergency department settings.
Common Pitfalls
- Billing K735 when the referring physician is not a physician or nurse practitioner, as this violates the mandatory referral source requirement.
- Submitting K735 for a standard patient transfer request that does not include a formal clinical opinion or specific management recommendations.
- Attempting to bill K735 in conjunction with a formal in-person consultation (A-code) for the same patient on the same day, which will trigger a rejection.
Billing Tips
- Ensure your documentation explicitly lists the name and billing number of the referring physician, as this is essential for audit verification of the K735 claim.
- Always record the start and end times of the telephone call in the patient's chart to substantiate the service provided under the K735 criteria.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Virtual Care Services
The consultant physician is required to review all relevant data provided by the referring physician or nurse practitioner.
A service rendered by a Medical Trainee is only eligible for payment to the Supervising Physician when the medical record of the patient(s) identifies the Supervising Physician, the Medical Trainee and level of training, the description of the insured service performed, patient consent for supervision, and the Supervising Physician has reviewed the service and signed off on the patient's medical record.
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