A021 – Complex dermatology assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation for the investigation, diagnosis, and management of complex diseases of the integumentary system where the complexity of the condition requires the medical expertise of a specialist in Dermatology (02).
When to Use
- Bill A021 for the initial referral of a patient with suspected dermatomyositis requiring specialist dermatological investigation and diagnosis.
- Use A021 when a patient is referred for evaluation of prurigo nodularis that has not responded to initial treatments, necessitating a specialist's complex assessment.
- A021 is appropriate for a patient referred with a widespread drug hypersensitivity syndrome involving significant skin manifestations, requiring specialist dermatological management.
Common Pitfalls
- Billing A021 when the patient's condition is already under ongoing management by the dermatologist; this scenario should be billed as an assessment code like A020.
- Submitting A021 without a valid written referral from a physician, NP, or dental surgeon, or failing to retain a copy of this referral in the chart.
- Claim rejection due to not including the referring provider's OHIP billing number on the A021 claim.
Billing Tips
- Ensure the 30-minute direct patient contact time requirement for complex psoriasis or dermatitis is met and documented; this time excludes charting or reviewing external reports.
- If the criteria for A021 are not fully met, consider billing A023 (Specific Assessment) or A024 (Partial Assessment) instead of A021 to avoid payment adjustments.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultation
Requires a written request from a referring physician, nurse practitioner, or dental surgeon (for hospital-based dental procedures).
Requires a written report (including findings, opinions, and recommendations) to the referring provider.
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 request identifies the consultant by name and/or the specialty being consulted, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.
The written request sets out the information relevant to the referral and specifies the service(s) required.
Where the referral is made by a nurse practitioner, the consultant shall provide the report to the nurse practitioner and the patient’s primary care provider, if applicable.
A021 is distinct from A020 (Complex Dermatology Assessment). A021 is for the initial investigation/diagnosis (Consultation), while A020 is for ongoing management (Assessment).
The 30-minute time requirement for psoriasis/dermatitis is specific to the consultation (A021); the assessment (A020) only requires 15 minutes.
Non-patient-facing time (charting, reviewing imaging) is excluded from the time calculation.
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