K738 – Physician to physician e-consultation – Referring physician
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Physician/nurse practitioner to physician e-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") who is competent to give advice in the particular field because of the complexity, seriousness, or obscurity of the case and where both the request and opinion are sent by electronic means through a secure server. This service is only eligible for payment if the consultant physician has provided an opinion and/or recommendations for patient treatment and/or management within thirty (30) days from the date of the e-consultation request. Definition/Required elements of service – Referring physician The referring physician or nurse practitioner initiates the e-consultation with the intention of continuing the care, treatment and management of the patient. In addition to the Constituent and Common Elements of Insured Services described in the General Preamble of this Schedule, this service includes the transmission of relevant data to the consultant physician and all other services rendered by the referring physician or nurse practitioner to obtain the advice of the consultant physician. For the purpose of this service, “relevant data” includes family/patient history, history of the presenting complaint, laboratory and diagnostic tests, where indicated.
When to Use
- Use K738 when you require specialist input on a complex case but intend to retain primary management of the patient rather than transferring care via a formal A005 or A007 consultation.
- Use K738 when seeking clinical guidance on medication adjustments or diagnostic interpretation for a patient where a face-to-face specialist visit is not immediately necessary or feasible.
Common Pitfalls
- Billing K738 without ensuring the consultant physician has actually provided a written response within the 30-day window, as this is a mandatory requirement for the service to be considered complete.
- Attempting to bill K738 for informal 'curbside' discussions that occur via phone or non-secure messaging, as the code strictly requires the use of a secure electronic platform.
Billing Tips
- You may bill K738 in addition to a standard office visit (e.g., A001) on the same day, as it is specifically exempted from the same-day service restrictions that apply to many other codes.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Other
Virtual Care Services
All insured services must be documented in appropriate records to establish that: an insured service was provided; the service for which the account is submitted is the service that was rendered; and the service was medically necessary.
The Definition/Required elements of service and payment rules for consultations in the General Preamble are not applicable to physician/nurse practitioner to physician e-consultations.
This service is eligible for payment in addition to visits or other services provided to the same patient on the same day by the same referring physician.
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