K738 OHIP Billing Code: Streamline Patient Management with E-Consultations

K738 is an OHIP billing code for physician-to-physician e-consultations initiated by a referring physician or nurse practitioner. This service allows primary care providers, typically in family medicine, to seek specialist input via electronic communication. The consultation is designed to continue the patient’s treatment and care management without an in-person referral.

Family physicians commonly use this billing code to manage cases where expert advice is needed but the patient doesn’t require immediate specialist intervention. This often occurs in managing complex chronic conditions or when diagnostic clarity is needed. Since this code does not require the same formal consultation definitions as in-person services, it is advantageous for streamlining patient management.

Despite its practicality, K738 is often overlooked due to misunderstandings about eligibility or documentation requirements, particularly because it does not follow traditional consultation rules.

Eligibility for Billing K738

• The service is limited to one service per patient per day and six services per patient every 12 months by any physician.
• Physicians can bill a maximum of 400 services per 12 month period.
• K738 cannot be billed for arranging a transfer of patient care or coordination of other consultation services or services mostly focusing on diagnostic result discussions.
• The service requires initiating an e-consultation with the intent of continuing patient care with the detailed opinion of the consultant.
• If the referring physician receives compensation outside the fee-for-service model, the service is ineligible for payment.

Please note that K738 is eligible even if other visits or services are concurrently provided to the same patient by the referring physician. However, it cannot coincide with consultation services by the consultant on the same or next day.