K997 – Additional Person(s) seen
OHIP Consultation & Visit Premium Codes Code — GENERAL PREAMBLE · Schedule of Benefits
The K997 premium is payable for each additional patient seen by a physician during a non-elective special visit to an Emergency Department. A special visit is defined as a visit initiated by a patient or on behalf of a patient for a non-elective service. This premium applies when the service for the additional patient commences at night, between 00:00 and 07:00. The premium is claimed in addition to the appropriate A-prefix assessment fee from the 'General Listings'. This premium is not eligible for payment to physicians who are designated as 'Emergency Department Physicians' (as defined on ), who must use a different set of premiums.
When to Use
- Use K997 when you are called into the Emergency Department for a non-elective visit and assess a second patient during the same trip between 00:00 and 07:00.
- Apply K997 for each subsequent patient seen after the first patient (who triggers the initial K996) during the same nocturnal emergency call-out.
Common Pitfalls
- Claiming K997 when you are the designated Emergency Department physician on duty, which is strictly prohibited under GP67.
- Billing K997 for patients seen after the established volume limits for special visit premiums, which requires switching to H-prefix codes instead.
- Failing to document the exact start time of the assessment for each additional patient, which is required to justify the nocturnal premium.
Billing Tips
- Always pair K997 with the appropriate A-prefix assessment code (e.g., A007) to ensure the claim is processed correctly as a special visit service.
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. When a special visit service occurs in a hospital, emergency department or long-term care institution where common medical records are maintained, the time when the visit takes place may be documented anywhere in the common medical record.
Submit claims using the appropriate A-prefix assessment fee from the “General Listings” for an assessment rendered in conjunction with a special visit premium.
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