K735

PDF page 171 / A43

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.

PDF page 172 / A44

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 3048. Record Layout PDF, page 1.

K73520260401999999990000047750000000000000000000000000000000000000000000000

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.