K993 – Additional Person(s) seen
OHIP Consultation & Visit Premium Codes Code — GENERAL PREAMBLE · Schedule of Benefits
K993 is a special visit premium for an additional patient seen in an Emergency Department. It is payable when a physician makes a previously unscheduled, non-elective visit to the ED during weekday daytime hours (07:00-17:00) that requires the sacrifice of regularly scheduled office hours. Key Conditions: - Service Type: Must be a non-elective service initiated by or on behalf of the patient. - Location: Emergency Department. - Time: Visit must be rendered between 07:00 and 17:00 on a weekday (Monday to Friday). - Sacrifice of Office Hours: The physician must have delayed or cancelled a booked office visit with another patient to attend this non-elective call. See for full definition. - Additional Patient: This premium applies to the second and subsequent patients seen during the same special visit, after the 'First Person Seen' premium (K992) has been claimed for the first patient. This premium is claimed in addition to an appropriate A-prefix assessment fee from the General Listings. It is not eligible for payment to Emergency Department Physicians as defined on .
When to Use
- Use K993 for the second or subsequent patient encountered during the same trip to the ED where you have already claimed K992 for the first patient.
- Apply this code when you are called away from your private office to the ED for a non-elective assessment and see multiple patients before returning to your office.
Common Pitfalls
- Claiming K993 without a corresponding K992 for the first patient seen during the same trip will result in an automatic rejection.
- Billing K993 alongside 'H' prefix emergency department codes is prohibited; you must use 'A' prefix assessment codes from the General Listings.
- Attempting to claim this premium as an ED physician (as defined in GP67) is a common audit trigger that leads to full recovery of funds.
Billing Tips
- Ensure the exact time of the visit is documented in each patient's chart, as this is the primary evidence required to justify the 'sacrifice of office hours' requirement.
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 )*
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