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L864
L864 – Surgical Pathology, Level 4
OHIP Diagnostic and Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Gross and microscopic examination of the following specimens: artery (biopsy); bone marrow (biopsy); bone exostosis; brain or meninges (other than neoplasm resection); branchial cleft cyst; breast (biopsy, not requiring microscopic evaluation of surgical margin; reduction mammoplasty); bronchus (biopsy); cell block; cervix (biopsy); digestive tract (biopsy); endocervix (biopsy or curettings); endometrium (biopsy or curettings); extremity (traumatic amputation); fallopian tube (biopsy; ectopic pregnancy); femoral head (fracture); digit (non-traumatic amputation); heart valve; joint (resection); kidney (biopsy); larynx (biopsy); lip (biopsy; wedge resection); lung (transbronchial biopsy); lymph node (biopsy); muscle (biopsy); nasal mucosa, nasopharynx or oropharynx (biopsy); nerve (biopsy); odontogenic or dental cyst; omentum (biopsy); oral or gingival mucosa (biopsy); ovary with or without fallopian tube (non-neoplastic); ovary (biopsy, wedge resection); paranasal sinus (biopsy); parathyroid gland; pericardium (biopsy); peritoneum (biopsy); pituitary gland (neoplasm); placenta (other than third trimester); pleura (biopsy); polyp (cervical; endometrial; digestive tract); prostate (needle biopsy; transurethral resection); salivary gland (biopsy); skin (other than cyst / tag / debridement / plastic repair); synovium; spleen; testis (other than biopsy, castration or neoplasm); thyroglossal duct cyst; tongue (biopsy); tonsil or adenoid (biopsy); trachea (biopsy); ureter (biopsy); urethra (biopsy); urinary bladder (biopsy); uterine contents (spontaneous or missed abortion); uterine leiomyoma (myomectomy); uterus with or without tubes and ovaries (for prolapse); vagina (biopsy); vulva (biopsy). In addition to the common elements, Laboratory Medicine services include interpretation of the results, a written interpretative report to the referring provider (if other than the interpreting physician), and providing premises, equipment, supplies and personnel for any constituent element performed elsewhere.
Referral requiredFrom: Physician, NursePractitioner
In accordance with the Health Insurance Act, the medical record must establish that: an insured service was provided; the service for which the account is submitted is the service that was rendered; and the service was medically necessary.
If supervised by a Supervising Physician, the service rendered by a Medical Trainee is only eligible for payment when the medical record of the patient identifies the Supervising Physician, the Medical Trainee and level of training, the description of the insured service performed by the Medical Trainee, and patient consent to the Supervision. The Supervising Physician must have reviewed the nature and outcome of the service and the patient record(s) with the Medical Trainee and signed off on the service.
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