K992 – First Person Seen
OHIP Consultation & Visit Premium Codes Code — GENERAL PREAMBLE · Schedule of Benefits
This is a premium payable for the first patient seen during a non-elective special visit to an Emergency Department. This specific premium applies on weekdays (Monday to Friday) from 07:00h to 17:00h when the physician must sacrifice scheduled office hours. As per , sacrifice of office hours occurs when a previously unscheduled non-elective visit causes a delay or cancellation of a booked office visit. This premium is not payable to Emergency Department Physicians (see definition on ). The time of the visit must be documented in the medical record. It must be claimed with an appropriate 'A' prefix assessment code.
When to Use
- Use K992 when you are called to the ED for a non-elective assessment during weekday business hours (07:00-17:00) and must cancel or delay a pre-booked office patient to attend.
- Use this code when providing an urgent consultation or assessment in the ED that does not qualify as an Emergency Department Physician service, provided you have sacrificed scheduled office time.
Common Pitfalls
- Billing K992 while simultaneously billing an office visit for the same time period will trigger an audit, as the code explicitly requires the sacrifice of office hours.
- Claiming K992 as an Emergency Department Physician is a common rejection; ensure your specialty designation in the OHIP system does not conflict with the GP67 definition of an ED physician.
- Failing to document the exact start time of the ED visit in the patient record is a frequent cause for clawbacks during Ministry audits.
Billing Tips
- Always pair K992 with an appropriate 'A' prefix assessment code (e.g., A007) to ensure the claim passes the validation rules for special visit premiums.
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.
*Not eligible for payment to Emergency Department Physicians (see definition )*
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.