All codes
T312
T312 – T312
OHIP Other Code · Schedule of Benefits
When to Use
- Use T312 for the initial consultation of a patient referred for a complex surgical or non-surgical assessment when the service meets the criteria for a formal specialist consultation.
- Select T312 when the patient has not been seen by your specialty for the current condition within the previous 12 months, distinguishing it from a repeat visit or follow-up.
- Apply this code when providing a comprehensive written report to the referring physician, which is a mandatory requirement for the T312 fee.
Common Pitfalls
- Billing T312 when the patient has been seen by your specialty for the same diagnosis within the last year, which should instead be billed as a follow-up visit.
- Submitting T312 without a valid referring physician number or failing to document the referral source, leading to automatic rejection.
- Attempting to bill T312 in conjunction with a procedure code on the same day without ensuring the consultation is distinct and medically necessary beyond the procedure itself.
Billing Tips
- Ensure the referral is documented in the patient chart with the referring physician's name and billing number to satisfy audit requirements for a formal consultation.
- If the patient is seen for a new, unrelated condition within the 12-month window of a previous visit, append the appropriate diagnostic code to justify the new consultation fee.
Provider Fee$196.00
Specialist Fee$196.00
Effective: February 1, 2011
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