All codes
T268
T268 – T268
OHIP Other Code · Schedule of Benefits
When to Use
- Use T268 for the primary assessment of a patient presenting with a specific psychiatric emergency or crisis requiring immediate intervention.
- Apply this code when performing a comprehensive psychiatric evaluation in an emergency department setting that exceeds the scope of a standard A007 assessment.
- Utilize T268 when the clinical encounter involves a detailed risk assessment for self-harm or violence that necessitates a formal psychiatric disposition.
Common Pitfalls
- Billing T268 in conjunction with a standard A007 or A001 visit on the same day will trigger an automatic rejection for duplicate service.
- Failing to document the specific psychiatric nature of the crisis can lead to audit recovery, as the code is strictly reserved for psychiatric emergency assessments.
- Attempting to bill T268 for routine follow-up care or non-emergent psychiatric consultations is a frequent cause of claim adjustment.
Billing Tips
- Ensure the clinical note explicitly justifies the emergency nature of the psychiatric evaluation to support the higher fee compared to standard consultation codes.
- If the patient requires a prolonged period of observation following the initial assessment, consider whether a K-code or time-based psychiatric management code is more appropriate than a single T268 claim.
Provider Fee$78.56
Specialist Fee$78.56
Effective: February 1, 2011
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