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K738
K738 – Physician to physician e-consultation – Referring physician
OHIP Consultations and Visits 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.
Referral requiredFrom: Physician, NursePractitioner
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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