K739 – Physician to physician e-consultation – Consultant 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. For the purpose of this service, “relevant data” includes family/patient history, history of the presenting complaint, laboratory and diagnostic tests, where indicated. The consultant physician service includes all services rendered by the consultant physician to provide opinion/advice/recommendations on patient care, treatment and management to the referring physician or nurse practitioner. The consultant physician is required to review all relevant data provided by the referring physician or nurse practitioner. Where a service is requested by a nurse practitioner, the consultant physician shall provide the report to the nurse practitioner and the patient's primary care provider, if applicable.
When to Use
- Use K739 when providing a formal, written specialist opinion via a secure platform in response to a specific clinical question from a primary care provider, rather than performing a traditional face-to-face consultation.
- Use K739 for managing complex cases where the referring provider seeks treatment recommendations or diagnostic clarification without requiring the patient to travel for an in-person assessment.
Common Pitfalls
- Claiming K739 for informal advice provided via phone, text, or unsecure email, which fails the mandatory secure server requirement.
- Submitting the claim without including the referring physician's or nurse practitioner's billing number, which is a mandatory field for successful processing.
- Billing K739 when the response is merely a referral for an in-person visit rather than providing actionable clinical management advice or a formal opinion.
Billing Tips
- Ensure the electronic record contains the full exchange, including the specific clinical question and your detailed management plan, to satisfy audit requirements for 'relevant data' review.
- Verify that the response is provided within the 30-day window from the initial request, as exceeding this timeframe invalidates the claim for K739.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Virtual Care Services
The consultant physician must include the referring physician's or nurse practitioner's provider number with the claim.
An e-consultation is only eligible for payment if all of the following elements are included in the patient's permanent medical record of the consultant physician: 1. patient's name and health number; 2. name of the referring physician or nurse practitioner; 3. date of, and reason for, the request; and 4. opinion, diagnosis, advice and/or recommendations of the consultant physician.
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.
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