All codes
T926
T926 – T926
OHIP Other Code · Schedule of Benefits
When to Use
- Use T926 for the initial assessment and management of a patient presenting with a new, acute minor trauma or injury that does not require a formal consultation.
- Select T926 when providing a comprehensive evaluation for a patient with a musculoskeletal injury that requires physical examination and a treatment plan, but does not meet the criteria for a minor procedure code like G372.
- Apply T926 for follow-up assessments of trauma patients where the complexity of the ongoing injury management exceeds the scope of a standard A007 or A001 visit.
Common Pitfalls
- Billing T926 in conjunction with a minor procedure code on the same day is often rejected unless the trauma assessment is distinct and documented as separate from the procedure.
- Using T926 for routine chronic condition follow-ups will trigger audit flags, as this code is strictly reserved for acute trauma-related encounters.
- Failure to include the specific injury diagnosis code (ICD-9) associated with the trauma will result in automatic rejection by the Ministry.
Billing Tips
- Ensure the clinical notes explicitly state the mechanism of injury and the physical findings related to the trauma to justify the use of T926 over a standard office visit code.
- If the encounter involves both a trauma assessment and a separate, unrelated chronic disease management issue, bill the trauma code as the primary service and use the appropriate diagnostic code to prevent claim bundling.
Provider Fee$67.87
Specialist Fee$81.42
Effective: February 1, 2011
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