A035 – Consultation
OHIP General Listings Code — General Surgery (03) · Schedule of Benefits
A consultation rendered by a specialist in General Surgery (03) following a written request from a referring physician, nurse practitioner, or dental surgeon.
When to Use
- Bill A035 when a specialist surgeon provides an initial opinion on a complex surgical case referred by a family physician, and the patient is seen in the surgeon's office or an outpatient department.
- Use A035 for a specialist surgical opinion on a patient's condition that is distinct from a previous surgical issue managed by the same surgeon, provided it meets the usage limits.
- A035 is appropriate when a specialist surgeon reviews a patient's case and provides recommendations to the referring provider, even if no immediate surgical intervention is planned.
Common Pitfalls
- Claiming A035 when the service provided was a pre-operative assessment for a low-risk elective procedure without sufficient documentation of medical necessity.
- Billing A035 when the surgeon spends 50 minutes or more in direct patient contact; A935 should be used instead.
- Failure to send a written report to the referring provider will result in the fee being reduced to a lesser assessment fee, as per the same-day restrictions.
Billing Tips
- Ensure the written request from the referring provider clearly identifies the consultant, referrer, and patient, and is retained in the patient's chart.
- If a consultation is requested by a medical trainee, the fee payable will be adjusted to that of a general or specific assessment.
Effective: June 1, 2025
Consultations and Visits
General Surgery (03)
Consultation
Consultation
A written report (including findings, opinions, and recommendations) must be sent to the referring provider.
The consultant must perform a general, specific, or medical specific assessment, including a review of all relevant data.
The medical record must contain a copy of the signed written request (except in common-record environments like hospitals).
The request must identify the consultant, the referrer (name and billing number), and the patient (name and health number).
Pre-operative consultations for low-risk elective procedures (cataract surgery, colonoscopy, cystoscopy, carpal tunnel surgery, arthroscopic surgery) are only eligible if the medical record demonstrates the consultation is medically necessary.
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