A045 – Consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon (for hospital-based dental procedures). The consultant physician, competent in neurosurgery, provides an opinion on a complex, serious, or obscure case, or when requested by the patient/representative. The service includes all necessary elements to prepare a written report with findings, opinions, and recommendations.
When to Use
- Bill A045 when a neurosurgeon provides an opinion on a complex neurological case following a written request from a family physician.
- Use A045 for a consultant physician providing an opinion on a rare condition, as requested in writing by a nurse practitioner.
- A045 is appropriate when a specialist provides a written opinion on a serious case, requested in writing by a dental surgeon for a hospital-based procedure.
Common Pitfalls
- Billing A045 without a written request from a referring physician, nurse practitioner, or dental surgeon will lead to rejection.
- Failure to provide a written report of findings, opinions, and recommendations to the referring provider is a common reason for A045 rejection.
- Submitting A045 when the patient is an emergency department patient being seen by the ED physician on duty will result in incorrect billing; C045 or other appropriate codes should be used.
Billing Tips
- Ensure the written request for A045 includes the referring provider's OHIP billing number and the patient's health number.
- Retain a signed copy of the written request for A045 in your medical records to support the claim.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultation
A written request from a referring physician, nurse practitioner, or dental surgeon is mandatory.
The consultant must provide a written report (findings, opinions, and recommendations) to the referring provider.
A signed copy of the written request must be maintained in the consultant's medical record.
The request must identify the consultant, the referring provider (including billing number), and the patient (name and health number).
The request must specify the services required and relevant clinical information.
Preoperative consultations for low-risk elective procedures (e.g., cataract, colonoscopy) are only payable if medically necessary and documented as such.
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