All codes
T609
T609 – T609
OHIP Other Code · Schedule of Benefits
When to Use
- Use T609 for the initial consultation of a patient with a suspected or confirmed diagnosis of a malignant neoplasm, provided the patient has not been seen by you for this specific condition in the previous 12 months.
- Select T609 when providing a comprehensive assessment for a new cancer diagnosis that requires a detailed treatment plan, distinguishing it from a standard A007 consultation.
Common Pitfalls
- Billing T609 for a follow-up visit or a routine check-up on a patient already under your care for the same malignancy, which should instead be billed as a subsequent visit code.
- Submitting T609 without the mandatory diagnostic code for the specific malignancy, which will trigger an automatic rejection from the Ministry.
Billing Tips
- Ensure your documentation explicitly reflects the complexity of the initial cancer assessment to justify T609 over a standard consultation code if audited.
- Verify that no other consultation or assessment code was billed for the same patient on the same day by the same physician, as T609 is a comprehensive service.
Provider Fee$67.38
Specialist Fee$67.38
Effective: February 1, 2011
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