K229 – Complex genetic test interpretation
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Complex genetic test interpretation is a time-based service only eligible for payment for interpretation of complex genetic tests done in association with a consultation or genetic care service. Complex genetic test interpretation includes interpretation done for any genetic testing where the laboratory report does not clearly explain the patient's phenotype or requires additional review to understand the implications of the result. Time units are calculated based on the duration of time spent exclusively interpreting the complex genetic tests, with a unit defined as ½ hour or a major part thereof. Refer to , and for detailed time-keeping requirements.
When to Use
- Use K229 when interpreting complex genomic sequencing results where the laboratory report is inconclusive or requires integration with clinical phenotype to determine patient management.
- Apply this code when the interpretation time exceeds the scope of a standard consultation (A005 or A007) and requires dedicated review of variant pathogenicity databases or literature.
Common Pitfalls
- Billing K229 without an associated consultation or genetic care service code will lead to automatic rejection.
- Failure to document exact start and end times in the chart is the most frequent cause of audit recovery for this code.
- Attempting to bill K229 for routine laboratory report review that does not meet the complexity threshold of a 'complex genetic test' as defined by the Schedule of Benefits.
Billing Tips
- Ensure your documentation explicitly justifies the complexity of the interpretation, specifically noting why the lab report required additional physician review beyond standard reporting.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Diagnostic
Diagnostic and Therapeutic Procedures
As this is a time-based service, the physician must record the start and end times in the patient's permanent medical record for the service to be eligible for payment.
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