All codes
T311
T311 – T311
OHIP Other Code · Schedule of Benefits
When to Use
- Use T311 for the initial consultation of a patient referred for a specific diagnostic assessment or management plan regarding a complex medical condition.
- Apply this code when the patient has not been seen by your specialty for the current condition within the preceding 12 months, satisfying the requirement for a new consultation.
- Select T311 when the service includes a comprehensive history, physical examination, and a written report to the referring physician, distinguishing it from a simple A007 assessment.
Common Pitfalls
- Billing T311 for a patient who has been seen by you or a partner in the same group for the same diagnosis within the last year, which will trigger a rejection for a repeat consultation.
- Failing to ensure a formal written referral is on file, as T311 requires a documented request from a referring physician or nurse practitioner to be valid.
- Attempting to bill T311 in conjunction with a minor procedure code on the same day without clear documentation of the separate diagnostic nature of the consultation.
Billing Tips
- Ensure the referral note is dated prior to the date of service to avoid automated rejections for missing referral information.
- If the patient requires follow-up visits after the T311, switch to the appropriate subsequent visit code (e.g., A005) to avoid audit scrutiny regarding the definition of a consultation.
Provider Fee$71.50
Specialist Fee$71.50
Effective: February 1, 2011
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