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L013
L013 – L013
OHIP Dermatology Code · Schedule of Benefits
When to Use
- Use L013 for the initial assessment and diagnostic workup of a patient presenting with a suspected malignancy or complex hematological disorder.
- Apply this code when the clinical complexity of a new cancer diagnosis requires a comprehensive review of investigations and treatment planning that exceeds the scope of a standard A007 consultation.
- Utilize L013 for patients requiring an extensive multidisciplinary care plan development that is not captured by standard office visit codes.
Common Pitfalls
- Billing L013 in conjunction with a standard A007 consultation for the same patient on the same day will trigger a rejection for duplicate service.
- Failing to document the specific complexity of the diagnostic process can lead to recovery during an audit, as the Ministry expects L013 to reflect higher intensity than routine visits.
- Using L013 for follow-up visits or routine monitoring, which should instead be billed under appropriate A-series follow-up codes.
Billing Tips
- Ensure the clinical record explicitly details the complexity of the diagnostic workup to justify the higher fee compared to standard consultation codes.
- Verify that the patient has not been billed for a consultation by the same physician within the preceding 12 months, as L013 is intended for distinct diagnostic episodes.
Provider Fee$103.40
Effective: July 1, 2010
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