When a specialist sees a patient at the written request of another physician, and completes a full evaluation to assess the specified condition, the specialist can bill a consultation. Each specialty has its own consultation code that is made up of the first two digits of the specialty code followed by a 5. For example, the outpatient or clinic consultation code for Internal Medicine (specialty code 13) is A135, for Neurology (specialty code 18) it’s A185 and for Cardiology (specialty code 60) it’s A605.
This is not, however, the only option a physician has for billing a consultation code.
Repeat consultations are additional consultations on a patient for the same or similar referring problem, separated by care rendered by another physician. For example, Internist Dr. J works at an allergy clinic and sees a patient referred by her family physician for a food allergy. This assessment would constitute a consultation A135. Now, let’s say the patient is discharged from the internists care and 8 months later develops a new food allergy that the family physician wants assessed. This new assessment by the internist would fit the criteria for a repeat consultation A136. Not surprisingly, repeat consultations pay less than the original consultation.
Limited consultations are consultations that are deemed by the specialist as being less demanding and time consuming than a full consultation. Otherwise, limited consultations have the same requirements as full consultations. The billing codes for limited consultations do not follow the same simple nomenclature or other assessment and consultation codes. For instance, for Internal Medicine, a limited consultation is A435, and again, pays less than a full consultation.
Comprehensive consultations are relatively new codes and are billed in those circumstances when the consultation takes much longer than a typical consultation. Specifically, comprehensive consultations for most specialties need to last a minimum of 75 minutes. This 75 minutes cannot include any time spent completing procedures or tests that are separately payable services, but the time does not need to be consecutive. Time requirements are crucial for these codes and physicians need to include the start and stop time in their consultation notes. These times do not need to be sent to OHIP, but they need to be in the notes in case the Ministry wants to review your billings. For Internal Medicine, the comprehensive consultation code is A130 and pays almost twice as much as a regular consultation.
Consultations on Children
For regular consultations on patients sixteen years of age or younger, most physicians are eligible to bill an A765. This code should be used instead of the regular consultation code and pays slightly more. In theory, the MOHLTC should have their system designed so that any full consultation sent on a patient sixteen years old or younger would be automatically upgraded to A765, but alas, their system is not set up that way. It’s up to the doctor and his or her billing company to make sure the A765 is billed when appropriate.
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