1What Is the K197 OHIP Code?
What is K197?
K197 is an OHIP billing code used by psychiatrists for individual out-patient psychotherapy sessions, billed per unit of time. This code is typically utilized in the ongoing treatment of conditions such as post-traumatic stress disorder or chronic mood disorders, where sessions often involve recurring weekly appointments.
Effective billing under K197 requires a minimum 20-minute session with the patient, where additional time is billed in further 30-minute increments. In clinical practice, sessions may last from 20 minutes to several hours, though a typical session might be around one hour.
Billing issues often arise from misunderstandings about the time requirements or same-day billing exclusions alongside consultations or other assessments, which can lead to rejections or non-compliance with OHIP policies.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A190 | Special psychiatric consultation | as per need | Used for comprehensive psychiatric evaluations. |
| A195 | Consultation | initial or once per condition | Standard psychiatric consultation for initial assessment. |
| A196 | Repeat consultation | as required | Follow-up consultations after an initial assessment. |
| A395 | Limited consultation | as needed | Shorter, focused consultations for specific issues. |
3Eligibility Requirements
Eligibility for K197
- Time Requirements: A minimum of 20 minutes of direct patient contact is required to qualify for billing K197. Each additional billing unit requires an extra 30 minutes of patient contact.
- Consecutive Time: Time spent with the patient must be consecutive, except for in-patient psychotherapy, where the time can be non-consecutive.
- Exclusions: K197 cannot be billed on the same day as a consultation or assessment for the same diagnosis by the same physician unless clearly defined as separate diagnoses.
- Additional Exclusions: Psychotherapy services cannot be billed on the same day as obstetrical delivery or an in-patient visit by the same psychiatrist to the same patient.
- Virtual Care: K197 can be billed for virtual sessions via video or telephone, designated as K197A.
4What Your Clinical Note Must Show
Ensure all services billed under K197 are supported by adequate documentation showing:
- Consecutive and adequate patient contact time.
- Records of the psychotherapy goals and patient progress.
- Evidence of a professional relationship aimed at symptom modification.
Keep detailed notes when services include:
- Separate times for non-consecutive in-patient sessions.
- Differentiation between psychotherapy and other billed services on the same day.
5Weak vs. Strong Note Examples
The strong note provides specific details about the session's duration, focus, and therapeutic strategy, ensuring compliance with OHIP requirements, whereas the weak note is vague and lacks the necessary documentation for billing.
Session with the patient lasted about 30 minutes. Discussed general mental well-being.
The patient's psychotherapy session lasted 46 minutes. Focus was on addressing ongoing symptoms of chronic mood disorder. Explored coping mechanisms and adjusted therapy plan to promote positive behaviors.
- Accurate session duration noted.
- Clear documentation of therapy content and progress.
- Session focus aligned with treatment objectives.
