A025 – Complex psoriasis or complex dermatitis
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
An assessment rendered following a written request from a referring physician, nurse practitioner or dental surgeon, including a general, specific or medical specific assessment, review of all relevant data, and preparation of a written report to the referring provider.
When to Use
- Bill A025 for a patient referred by a GP for a second opinion on a recalcitrant eczema unresponsive to initial topical therapies, requiring a detailed management plan.
- Use A025 when a patient is referred by a dermatologist for assessment of a newly diagnosed, widespread psoriatic arthritis with significant skin manifestations.
- A025 is appropriate for a patient referred by a nurse practitioner for evaluation of a severe, blistering dermatitis that does not fit a common diagnosis.
Common Pitfalls
- Billing A025 for a routine follow-up of a known dermatitis; A026 is the correct code for repeat consultations.
- Submitting A025 without a signed, written referral from the referring provider, which is a mandatory requirement.
- Using A025 when the patient is seen in an inpatient hospital setting for a special visit; A027 is the correct code in this scenario.
Billing Tips
- Ensure the written report to the referring provider is completed and kept on file; this is a key component of the A025 service.
- If the consultation is conducted via video, append the 'A' suffix to A025 and confirm the service was rendered via video.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultation
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.
Age-based premiums for patients under 16 years of age () apply to this code.
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