A130 – Comprehensive internal medicine consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered by a specialist in internal medicine who provides all the appropriate elements of a consultation and spends a minimum of seventy-five (75) minutes of direct contact with the patient, exclusive of time spent rendering any other separately billable intervention to the patient.
When to Use
- Bill A130 when a patient presents with complex, multi-systemic issues requiring a thorough diagnostic workup and management plan from an internal medicine specialist, and the encounter spans at least 75 minutes of direct patient contact.
- Use A130 for initial consultations on patients with undiagnosed chronic conditions that have failed to respond to initial management by a primary care provider, necessitating a deep dive by an internist.
- A130 is appropriate for patients with multiple comorbidities requiring comprehensive assessment and coordination of care, where the internist spends significant time evaluating the interplay of these conditions.
Common Pitfalls
- Billing A130 when the direct patient contact time is less than 75 minutes; this will likely result in the claim being adjusted to a lesser code like A135.
- Failing to document the start and stop times of the patient encounter in the medical record, which is a mandatory requirement for A130 and can lead to audits or claim rejections.
- Including time spent reviewing external records or dictating reports in the 75-minute minimum for A130; only direct patient contact time is billable for this code.
Billing Tips
- Ensure a valid referral from a physician, nurse practitioner, or dental surgeon is on file, clearly identifying the patient, referring provider, and the need for an internal medicine consultation.
- Remember to submit a comprehensive report of findings, opinions, and recommendations to the referring provider to fulfill the requirements of A130.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Specialist 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.
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.
A written report (including findings, opinions, and recommendations) must be provided to the referring physician, nurse practitioner or dental surgeon. 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.
Minimum of 75 minutes of direct contact with the patient is required.
The start and stop times of the service must be recorded in the patient’s permanent medical record.
Calculation of time excludes non-patient-facing time such as reviewing charts, imaging, or documentation.
Eligible for age-based fee premiums () for patients under 16 years of age.
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