All codes
T267
T267 – T267
OHIP Other Code · Schedule of Benefits
When to Use
- Use T267 for the initial assessment and management of a patient presenting with a specific acute injury or condition requiring a focused examination that exceeds a standard office visit.
- Apply this code when performing a comprehensive evaluation of a patient referred for a specific diagnostic opinion that does not meet the criteria for a full consultation code like A005.
- Utilize T267 for specialized procedural assessments where the complexity of the evaluation is higher than a routine follow-up but does not involve a surgical procedure.
Common Pitfalls
- Billing T267 in conjunction with a standard office visit code like A007 for the same patient on the same day will trigger an automatic rejection for duplicate service.
- Failing to document the specific clinical complexity that justifies the higher fee of T267 over a standard assessment code often leads to recovery during Ministry audits.
- Using T267 for routine follow-up care that should be billed under a standard visit code is a common cause of claim adjustments.
Billing Tips
- Ensure the clinical notes explicitly detail the diagnostic reasoning and the specific nature of the assessment to support the T267 fee if reviewed.
- Verify that no other assessment codes have been submitted for the same patient encounter to avoid billing conflicts.
Provider Fee$78.56
Specialist Fee$78.56
Effective: February 1, 2011
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