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T760
T760 – T760
OHIP Other Code · Schedule of Benefits
When to Use
- Use T760 for the initial assessment of a patient with a suspected or confirmed diagnosis of cystic fibrosis in a specialized clinic setting.
- Apply this code when performing a comprehensive multidisciplinary evaluation that exceeds the scope of a standard A007 or A005 office visit.
- Bill T760 when coordinating complex care plans for cystic fibrosis patients that require integration of respiratory, nutritional, and pharmacological management.
Common Pitfalls
- Do not bill T760 in combination with a standard A007 or A005 on the same day, as this is considered unbundling of services.
- Avoid using T760 for routine follow-ups that do not meet the criteria for a specialized cystic fibrosis assessment, as this will trigger audit flags for over-billing.
- Failure to document the specific multidisciplinary components of the visit will lead to claim rejection during manual review.
Billing Tips
- Ensure the patient's diagnosis code for cystic fibrosis is clearly linked to the T760 claim to justify the specialized nature of the consultation.
- If additional procedures or diagnostic tests are performed during the same encounter, ensure they are billed with appropriate diagnostic codes to avoid conflict with the T760 base fee.
Provider Fee$74.25
Specialist Fee$74.25
Effective: February 1, 2011
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