A026 – Complex psoriasis or complex dermatitis
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
An additional consultation rendered by the same consultant, in respect of the same presenting problem, following care rendered to the patient by another physician in the interval following the initial consultation but preceding the repeat consultation.
When to Use
- Bill A026 when a patient returns for follow-up on complex psoriasis or dermatitis after seeing another physician for the same issue in the interim.
- Use A026 for a dermatology consultation that requires a referral and follows an initial assessment by another physician for the same presenting problem.
- A026 is appropriate for a repeat consultation on complex skin conditions when the patient has been managed by a different physician since the initial consultation.
Common Pitfalls
- Billing A026 on the same day as an initial consultation (A025) for the same patient by the same physician will result in rejection.
- Failure to obtain and document a referral from a physician, nurse practitioner, or dental surgeon will lead to rejection of A026.
- Not submitting a written report to the referring physician along with the history and physical examination documentation can cause issues with A026 claims.
Billing Tips
- Ensure the patient's condition meets the complexity criteria for psoriasis or dermatitis (e.g., >30% BSA, systemic therapy, or 30+ minutes direct contact) to justify A026.
- A026 is not subject to the 1 per 24-month limit for initial consultations, allowing for more frequent repeat consultations when medically necessary and properly documented.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Repeat Consultation
Consultation
Must include a history, physical examination, and a written report to the referring physician.
Complexity criteria for Dermatology include >30% BSA involvement, systemic therapy, or 30+ minutes of direct contact.
Start and end times must be recorded if time-based criteria are used.
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