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T613
T613 – T613
OHIP Other Code · Schedule of Benefits
When to Use
- Use T613 for the initial consultation of a patient with a confirmed diagnosis of malignant neoplasm when the service requires a comprehensive assessment and treatment planning.
- Select T613 when the patient is referred by another physician for a formal consultation regarding complex oncological management that exceeds the scope of a standard A005 or A007 assessment.
Common Pitfalls
- Billing T613 for a follow-up visit is a common audit trigger; use appropriate follow-up codes like A007 or K030 instead.
- Submitting T613 without a valid referring physician number or failing to provide a written report to the referring physician will result in automatic claim rejection.
- Attempting to bill T613 in conjunction with a minor procedure code on the same day often leads to payment denials unless the procedure is unrelated to the consultation.
Billing Tips
- Ensure the consultation note clearly documents the complexity of the decision-making process to justify the higher fee compared to standard consultation codes.
- If the consultation exceeds the time threshold for a standard visit, consider if a time-based premium or specific procedural add-on is applicable to maximize the claim value.
Provider Fee$444.00
Specialist Fee$444.00
Effective: February 1, 2011
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