K731

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Definition/Required elements of service – Referring physician/Nurse Practitioner
     The referring physician or nurse practitioner initiates the telephone consultation with the
     intention of continuing the care, treatment and management of the patient.
     In addition to the Constituent and Common Elements of Insured Services described in the
     General Preamble of this Schedule, this service includes the transmission of relevant data to
     the consultant physician and all other services rendered by the referring physician or nurse
     practitioner to obtain the advice of the consultant physician.
       Note:
       This service is eligible for payment in addition to visits or other services provided to the same
       patient on the same day by the same referring physician.
    Definition/Required elements of service – Consultant physician
     This service includes all services rendered by the consultant physician to provide opinion/
     advice/recommendations on patient care, treatment and management to the referring
     physician. The consultant physician is required to review all relevant data provided by the
     referring physician or nurse practitioner.
 K730 Physician to physician telephone consultation - Referring
        physician .............................................................................                 37.05
 K731 Physician to physician telephone consultation - Consultant
        physician .............................................................................                 47.75

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CONSULTATIONS AND VISITS
 FAMILY PRACTICE & PRACTICE IN GENERAL (00)
          [Commentary:
          Referring and consultant physicians participating in physician to physician telephone
          consultations while on duty in an emergency department or a hospital urgent care clinic should
          submit claims using K734 and K735. K730 and K731 should not be claimed in these
          circumstances.]
          Payment rules:
          1.A maximum of one K730 or K734 service is eligible for payment per patient per day.
          2.A maximum of one K731 or K735 service is eligible for payment per patient per day.
          3.This service is only eligible for payment for a physician to physician telephone consultation
            service:
              a.that includes a minimum of 10 minutes of patient-related discussion for any given patient
              b.where the referring physician/nurse practitioner and consultant physician are physically
                present in Ontario at the time of the service
          4.This service is not eligible for payment to the referring or consultant physicians in the
            following circumstances:
              a.when the purpose of the telephone discussion is to arrange for transfer of the patient’s
                care to any physician;
              b.when rendered in whole or in part to arrange for a consultation, assessment, visit, or K-
                prefix time-based services, procedure(s), or diagnostic investigation(s);
              c.when rendered primarily to discuss results of diagnostic investigation(s); or
              d.when a consultant physician renders a consultation, assessment, visit, or K-prefix time-
                based service, on the same day or next day following the physician to physician
                telephone consultation for the same patient.
          5.In circumstances where a physician receives compensation, other than by fee-for-service
            under this Schedule, for participation in the telephone consultation, this service is not eligible
            for payment to that physician.

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CONSULTATIONS AND VISITS
FAMILY PRACTICE & PRACTICE IN GENERAL (00)
    Medical record requirements:
    Physician to physician telephone consultation is only eligible for payment where the following
    elements are included in the medical record for a physician who submits a claim for the service:
    1.patient’s name and health number;
    2.start and stop times of the discussion;
    3.name of the referring physician or nurse practitioner and consultant physician;
    4.reason for the consultation; and
    5.the opinion and recommendations of the consultant physician.
    Claims submission instructions:
    K731 and K735 are only eligible for payment if the consultant physician includes the referring
    physician’s or nurse practitioner’s provider number with the claim.
    [Commentary:
    1.In calculating the minimum time requirement, time does not need to be continuous. In
      circumstances where a physician to physician telephone consultation service with the
      consultant physician on the same day is not continuous, the total time represents the
      cumulative time of all telephone consultations with the same physicians on that day
      pertaining to the same patient.
    2.Payment, other than by fee-for-service includes compensation where the physician receives
      remuneration under a salary, primary care, stipend, APP or AFP model.
    3.Physicians who receive compensation other than by fee-for-service under this Schedule
      should consult their contract for guidance on shadow-billing.]

Master, record 3044. Record Layout PDF, page 1.

K73120260401999999990000047750000000000000000000000000000000000000000000000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.