All codes
Q638
Q638 – Q638
OHIP Critical Care Code · Schedule of Benefits
When to Use
- Use Q638 to bill the 'Chronic Disease Management Incentive' for patients with diabetes, hypertension, congestive heart failure, or COPD who have had at least two visits in the preceding 12 months.
- Apply this code when you have completed the required annual review and management plan for a patient enrolled in a formal chronic disease management program.
Common Pitfalls
- Billing Q638 on the same day as a comprehensive assessment (A007 or A008) is often flagged for audit as these services should be distinct.
- Submitting Q638 without documented evidence of the required two previous visits in the rolling 12-month period will lead to automatic rejection or recovery during a post-payment audit.
Billing Tips
- Ensure the patient's diagnosis code matches the specific chronic condition being managed, as Q638 is condition-specific and cannot be used for general wellness checks.
Provider Fee$0.00
Effective: October 1, 2008
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