A015 – Consultation
OHIP General Listings Code — Anaesthesia (01) · Schedule of Benefits
A consultation rendered by an anaesthesia (01) specialist following a written request from a referring physician, nurse practitioner, or dental surgeon (for hospital dental procedures) due to the complexity, seriousness, or obscurity of the case. The service includes a general, specific, or medical specific assessment and a written report to the referrer.
When to Use
- Bill A015 when an anaesthesia specialist provides a comprehensive assessment and written report for a complex, non-emergent case referred by a physician, NP, or dental surgeon, distinct from routine pre-operative assessments.
- Use A015 for an anaesthesia specialist's consultation on a patient with an obscure anaesthetic risk, requiring a detailed assessment and report, not covered by simpler assessment codes like A013 or A014.
- A015 is appropriate when an anaesthesia specialist is consulted for a patient with multiple comorbidities that significantly complicate anaesthetic planning, necessitating a formal written report to the referring physician.
Common Pitfalls
- Billing A015 for routine pre-anaesthetic evaluations, which are considered part of the anaesthesia service itself and are not separately billable as a consultation.
- Failing to obtain and retain a written request from the referring provider, or not providing a written report back to the referrer, leading to claim rejection or audit issues.
- Submitting A015 for a patient already managed by the anaesthesiologist for the same condition within the last 24 months, unless specific exceptions for unrelated diagnoses or hospital inpatients apply.
Billing Tips
- Ensure the written request clearly outlines the complexity or obscurity of the case, justifying the need for a formal consultation beyond a standard pre-anaesthetic assessment.
- When applicable, append age-based premiums (e.g., AGE_PREMIUM_LT_30_DAYS) to A015 for paediatric patients to accurately reflect the increased complexity and time required for assessment.
Effective: June 1, 2025
Consultations and Visits
Anaesthesia (01)
Consultations and Visits
Consultation
Written request from a referring physician, nurse practitioner, or dental surgeon (dental surgeon requests must be in connection with an insured dental procedure in a hospital).
The request must identify the consultant, the referrer (name and billing number), and the patient (name and health number).
The request must specify the information relevant to the referral and the services required.
A written report (including findings, opinions, and recommendations) must be provided to the referring provider.
The consultant must perform a general, specific, or medical specific assessment, including a review of all relevant data.
A copy of the written request for the consultation, signed by the referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician’s medical record, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.
The routine pre-anaesthetic evaluation of the patient does not constitute a consultation, regardless of where or when it is performed.
If the requirements for a consultation (e.g., written request, report) are not met, the fee will be reduced to a lesser assessment fee.
A015 is used for out-patients or patients in the Emergency/OPD when the physician is not on duty in that department.
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