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T022
T022 – T022
OHIP Other Code · Schedule of Benefits
When to Use
- Use T022 for the initial consultation of a patient with a suspected or confirmed malignancy when a formal written report is generated for the referring physician.
- Apply this code when the complexity of the oncological assessment requires a comprehensive review of diagnostic imaging, pathology reports, and staging investigations that exceeds a standard consultation.
- Select T022 instead of A005 when the clinical encounter is specifically focused on the management planning for a new cancer diagnosis.
Common Pitfalls
- Billing T022 for a follow-up visit instead of a subsequent assessment code like A007, which will trigger an automatic rejection or audit flag.
- Submitting T022 without a corresponding written consultation report on file, as the Ministry requires documented evidence of the formal referral and the resulting management plan.
- Attempting to bill T022 in conjunction with a minor procedure code on the same day, which is often disallowed unless the procedure is unrelated to the consultation.
Billing Tips
- Ensure the referral source is clearly identified in the claim, as T022 requires a valid referring physician number to be processed correctly.
- If the consultation involves a multidisciplinary team discussion, document the specific contribution to the management plan to justify the higher fee compared to standard consultation codes.
Provider Fee$299.89
Specialist Fee$299.89
Effective: February 1, 2011
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