All codes
T236
T236 – T236
OHIP Other Code · Schedule of Benefits
When to Use
- Use T236 for a formal consultation requested by a referring physician for a patient with a complex psychiatric condition requiring a comprehensive assessment and management plan.
- Select T236 when the patient has not been seen by your practice for the same diagnosis within the previous 12 months, distinguishing it from a repeat consultation (T237) or a follow-up visit (K013).
- Apply this code when the consultation requires a written report back to the referring physician that includes a detailed diagnostic impression and specific treatment recommendations.
Common Pitfalls
- Billing T236 for a patient who has been seen by you or a partner in the same group for the same condition within the last 12 months, which will trigger a rejection for a repeat consultation.
- Failing to ensure the referring physician's billing number is included in the claim, as T236 requires a valid referral to be processed by OHIP.
- Submitting T236 for a self-referred patient or a patient referred by a non-physician provider, which does not meet the Ministry requirements for a formal consultation.
Billing Tips
- Ensure the referral request is documented in the patient chart with the referring physician's name and the specific clinical question to support the T236 claim during an audit.
- If the consultation results in a prolonged assessment exceeding the standard time, consider whether the complexity justifies a K-code add-on, but ensure the primary T236 remains the base service.
Provider Fee$292.67
Specialist Fee$292.67
Effective: February 1, 2011
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