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T679
T679 – T679
OHIP Other Code · Schedule of Benefits
When to Use
- Use T679 for the specific surgical procedure defined in the Schedule of Benefits when performed as a primary intervention in an operating room setting.
- Select T679 when the clinical documentation confirms the completion of all mandatory procedural components, distinguishing it from minor diagnostic codes like G389.
Common Pitfalls
- Billing T679 in conjunction with other surgical codes that are considered 'included' in the global fee, leading to automatic rejection for unbundling.
- Failing to append the necessary diagnostic code that justifies the medical necessity of this high-value procedure, which triggers manual audit reviews.
Billing Tips
- Ensure the operative report explicitly details the time and complexity of the procedure to support the T679 claim if a post-payment audit occurs.
- Verify that no other procedural codes for the same anatomical site are billed on the same day, as T679 is typically subject to global surgical fee rules.
Provider Fee$1,000.00
Specialist Fee$1,000.00
Effective: February 1, 2011
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