All codes
T269
T269 – T269
OHIP Other Code · Schedule of Benefits
When to Use
- Use T269 for the initial assessment and management of a patient presenting with a specific acute condition requiring a comprehensive evaluation that exceeds the scope of a standard A007 office visit.
- Apply this code when performing a detailed consultation for a patient referred by another physician for a specific diagnostic problem, provided the requirements for a formal consultation are met.
Common Pitfalls
- Billing T269 in conjunction with a minor assessment code like A001 or A007 for the same patient on the same day will result in an automatic rejection for duplicate service.
- Failure to document the referring physician's name and billing number will trigger a rejection, as this is a mandatory field for consultation-level billing.
Billing Tips
- Ensure the clinical record explicitly supports the complexity of the visit to justify the higher fee compared to standard assessment codes, as this code is a frequent target for Ministry of Health post-payment audits.
Provider Fee$118.47
Specialist Fee$118.47
Effective: February 1, 2011
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