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Specialty/ Practitioner Type : Region Where Services Under Review Provided : Region Where Provider Currently Practicing (as of 07/31/01) : Period of Review : mm/dd/yy
    CODES REVIEWED
Referred to Review Committee
    CODES REVIEWED
Contained in Review Committee Decision
Recovery Amount * :
Family Practice and General Practice Central West Central West 05/01/96 to 02/28/97 A007, K013, W001, W002, W003, W008, W102 A007, K013, W001, W008 $3,567.37
Cardiology Central West Central West 01/01/97 to 12/31/98 A603, A604, A605 A603, A604, A605 $52,865.37
Family Practice and General Practice Central East Central East 05/01/96 to 07/31/96 A001, A004, A007, A994, A995, G467, G700, K007, K013 A001, A004, A007, A994, A995, G467, K007, K013, $10,625.00
Internal Medicine Central South Central South 05/01/96 to 04/30/98 A133, A134, A135 A133, A134, A135 $105,837.80
Internal Medicine Central South Central South 05/01/97 to 04/30/99 A135, A136 A135, A136 $110,000.00
Paediatrics Central East Central East 05/01/96 to 09/30/96 A007, A263, A264, A265, A266, K013 A263, A264, A266 $8,333.33
Psychiatry Central West Central West 09/01/96 to 08/31/98 A994, A995, K002, K003, K190, K195, K197 A994, A995, K003, K190, K197 $201,352.53
Gastroenterology Central East Central East 04/01/97 to 03/31/99 A413, A414, A415, K994, K995 A413, A414, A415, K994, K995 $34,557.30
Family Practice and General Practice Central South Central South 05/01/96 to 11/30/96 A003, A004, A007, K007, K013 A003, A004, A007, K007, K013 $2,208.91
Cardiology Central West Central West 05/01/96 to 04/30/98 A603, A604 A603, A604 $30,489.44

* The recovery amount includes amounts that pertain to services provided on or after May 1, 1996.


The Medical Review Committee cases noted above involve the referral of 71 different codes for review. However, it should be noted that of the codes referred for review, some codes were referred much more frequently than other codes. Codes that were more commonly referred include the following :


Code : Description : Percentage of Referrals from Cases Noted Above :
A007 Intermediate Assessment/Well Baby Care 57%
K013 Psychotherapy – counseling 33%
A003 General Assessment 30%
K007 Psychotherapy – individual care 23%
A004 General Re-assessment 17%
A133 General Assessment 17%
A135 Consultation 17%

Providers who have questions about claims for a given service are encouraged to contact their District Office and obtain clarification in writing.

More information about the review committee process is contained on the ministry’s website: http://www.health.gov.on.ca



Ontario Ministry of Health and Long-Term Care
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