K991 – Additional Person(s) seen
OHIP Consultation & Visit Premium Codes Code — GENERAL PREAMBLE · Schedule of Benefits
This is a premium for an additional person seen during a special visit to an Emergency Department. A special visit is a non-elective visit initiated by a patient or their representative (see ). This specific premium, K991, applies to an additional patient seen on a weekday between 07:00 and 17:00. It is payable with an appropriate assessment fee (e.g., 'A' prefix codes as per ). The time of the visit must be documented in the medical record. This premium is not payable to designated 'Emergency Department Physicians' as defined on .
When to Use
- Use K991 when you are called into the ED to see a second or subsequent patient during the 07:00-17:00 weekday window after having already billed a primary special visit premium.
- Apply K991 when you assess multiple patients during a single non-elective trip to the ED, provided the service for each additional patient commences within the 07:00-17:00 timeframe.
Common Pitfalls
- Billing K991 as an Emergency Department Physician; this code is strictly prohibited for those designated as ED physicians under GP67.
- Exceeding the maximum volume of 10 patients per special visit block; once the limit is reached, you must switch to 'H' prefix codes for all subsequent patients.
- Failing to document the exact start time of the assessment for the additional patient, which is a mandatory requirement for audit compliance.
Billing Tips
- Ensure the primary patient is billed with the appropriate special visit premium (e.g., K960) before attaching K991 to the subsequent patient claims.
- Always verify that the service is non-elective and initiated by the patient or their representative, as K991 is not applicable for routine rounding or elective consultations.
Effective: April 1, 2026
GP. General Preamble
GENERAL PREAMBLE
Premium
Special Visit Premiums (Table I - Emergency Department)
The time at which the special visit takes place must be documented on the medical record.
An additional person premium is only eligible for payment for services rendered at the destination to additional patients seen in emergency departments, outpatient departments, long-term care institutions or to hospital inpatients, provided that each additional patient service is commenced during the eligible times.
This premium is for an 'Additional Person(s) seen' during 'Weekdays Daytime (07:00-17:00)'.
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