1What Is the K195 OHIP Code?
What is K195?
K195 is an OHIP billing code used for family psychotherapy sessions conducted by psychiatrists on an outpatient basis. These sessions must involve two or more members of the patient's household and are billed in units based on time spent. This code is particularly relevant for cases such as an adolescent with an eating disorder or patients experiencing relapses influenced by household dynamics.
The service must last at least 20 consecutive minutes to bill a single unit, with every additional unit requiring an additional 30 minutes. Importantly, the code is designed for situations where the therapist works directly with the family to address emotional and behavioral issues affecting the patient.
Often, billing for this code may be missed if the clinical focus of the session is not clearly documented or if the family members' involvement in the therapy is not properly recorded.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A190 | Special psychiatric consultation | One-time consultation for complex psychiatric evaluation | Used for comprehensive initial psychiatric assessments. |
| A195 | Consultation | Occasional consultation for psychiatric evaluation | For standard psychiatric consultations. |
| A196 | Repeat consultation | Re-evaluation with repeat consultation | For follow-up psychiatric evaluations when circumstances require. |
| A395 | Limited consultation | Limited scope psychiatric evaluation | For consultations requiring a quick or limited evaluation. |
3Eligibility Requirements
Eligibility Requirements for K195
- Consecutive Time Requirement: K195 can only be billed if the psychotherapy session is conducted for a minimum of 20 consecutive minutes for one unit. Each additional unit requires another 30 consecutive minutes.
- Family Members Present: The service involves the patient and one or more household members.
- Service Location: The psychotherapy must occur outside of a hospital setting.
- Non-overlapping Services: K195 cannot be billed on the same day as a consultation or assessment for the same diagnosis by the same physician unless distinctly different diagnoses are documented.
- Virtual Care: Can be rendered via video or telephone, billed as K195A, under virtual care provisions.
- Exclusions: Not payable with any obstetrical delivery services by the same physician to the same patient on the same day.
4What Your Clinical Note Must Show
Ensure accurate patient records with the following:
- Start and end times of the session indicating consecutive time.
- Names and roles of family members present during the session.
- Therapeutic goals addressed for the session relevant to the family context.
- Indication of distinct diagnosis if billed on the same day as another service.
5Weak vs. Strong Note Examples
The strong note succeeds because it details the session's start and end times, the specific family dynamics addressed, and includes who was present, thereby meeting billing documentation standards. The weak note fails to capture these critical elements.
Session held with family. Discussed issues.
Conducted 76-minute family psychotherapy session with patient and parents present. Reviewed coping strategies for managing interpersonal conflicts that exacerbate the patient's eating disorder.
- Session start: 10:00 AM, end: 11:16 AM.
- Mother and father in attendance.
- Focus: Patient's anxiety exacerbated by family dynamics.
