K223 – Clinical interpretation by a geneticist
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Clinical interpretation by a Geneticist requires interpretation of pertinent pedigrees (which must contain a comprehensive ancestral history), and/or cytogenetic, biochemical, or molecular genetic reports. The service must be requested in writing by a physician who is participating in the patient's care and the geneticist must submit his/her findings, opinions, and recommendations in writing to the referring physician.
When to Use
- Use K223 when providing a formal written genetic interpretation of complex molecular or biochemical lab reports requested by a primary care physician or specialist for a patient not currently undergoing a full consultation.
- Use this code when performing a detailed pedigree analysis for risk assessment that does not meet the full requirements or time threshold of a formal consultation (A005 or similar).
Common Pitfalls
- Billing K223 on the same day as a formal consultation (A005, A007, etc.) for the same patient will result in an automatic rejection.
- Failing to retain a copy of the written request from the referring physician or the written report sent back to them will lead to full recovery of funds during a Ministry audit.
- Using K223 for routine genetic counseling that lacks the specific requirement of interpreting complex lab reports or comprehensive pedigrees as defined in the Schedule.
Billing Tips
- Ensure your written report to the referring physician is dated and explicitly references the specific genetic or biochemical reports interpreted to satisfy the audit trail requirements.
- If the interpretation requires significant time beyond the scope of K223, evaluate if the service qualifies as a formal consultation (A-prefix) instead, noting that you cannot bill both for the same encounter.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Diagnostic
Diagnostic and Therapeutic Procedures
A written request from a physician participating in the patient's care.
The geneticist must submit findings, opinions, and recommendations in writing to the referring physician.
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