K999 – Additional Person(s) seen
OHIP Consultation & Visit Premium Codes Code — GENERAL PREAMBLE · Schedule of Benefits
K999 is a special visit premium for an 'Additional Person(s) seen'. It is applicable for non-elective services rendered in an Emergency Department on Saturdays, Sundays, and Holidays between 07:00 and 24:00. This premium is for the second and subsequent patients seen during a single special visit, after the first patient has been claimed with the corresponding 'First Person Seen' premium (K998). It must be claimed with an appropriate 'A' prefix assessment code from the General Listings. This premium is specifically not eligible for payment to physicians defined as 'Emergency Department Physicians' as per . As per , the time at which the special visit takes place must be documented in the patient's medical record.
When to Use
- Use K999 for the second or subsequent patient encountered during a single trip to the Emergency Department on weekends or holidays, provided you have already claimed K998 for the first patient.
- Apply this code when you are called in to see multiple patients in the ED during the same special visit window, ensuring each patient's service start time is documented.
Common Pitfalls
- Billing K999 if you are designated as an Emergency Department Physician under GP67, as this code is strictly prohibited for those providers.
- Claiming K999 without a corresponding 'A' prefix assessment code, which will result in an automatic rejection.
- Failing to document the exact start time of the service in the patient's chart, which is a mandatory requirement for audit compliance under GP69.
Billing Tips
- Ensure you only claim K999 for patients seen after the initial K998 claim; if you see three patients, you should claim one K998 and two K999s.
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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