A155 – Consultation - Endocrinology
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered by a specialist in Endocrinology & Metabolism following a written request from a referring physician, nurse practitioner, or dental surgeon, including a written report to the referring provider.
When to Use
- When an endocrinologist provides a comprehensive assessment for a newly diagnosed complex endocrine disorder, such as Cushing's disease, requiring specialist input beyond the scope of primary care.
- When a patient with poorly controlled diabetes requires a specialist endocrinologist's evaluation for advanced management strategies, including initiation of complex insulin regimens or consideration for bariatric surgery, following a referral.
- When a patient presents with suspected pituitary dysfunction (e.g., hypopituitarism) and requires a detailed endocrine workup and management plan from a specialist, supported by a referral.
Common Pitfalls
- Billing A155 when the patient was not referred by a physician, nurse practitioner, or dental surgeon; ensure the written referral is retained in the chart.
- Submitting A155 without a comprehensive written report to the referring provider; this report is a mandatory component for payment.
- Claiming A155 for a follow-up visit that should be billed as an A156 (Repeat Consultation) or an appropriate visit code, as A155 is for the initial consultation.
Billing Tips
- Ensure the written referral for A155 clearly states the reason for consultation and the specific endocrine issue being addressed.
- Verify that the written report sent to the referring provider includes findings, opinions, and clear recommendations for ongoing management.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultation
Written request from a referring physician, NP, or dental surgeon must be kept in the consulting physician’s medical record (unless common records in 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.
Written report including findings, opinions, and recommendations sent 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).
Must include a general, specific or medical specific assessment, including a review of all relevant data.
Eligible for special visit premiums if criteria are met ().
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