A160 – Comprehensive nephrology consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered by a specialist in nephrology 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 A160 for a new patient presenting with complex, undiagnosed glomerulonephritis requiring extensive history, physical, and review of multiple prior investigations, necessitating a full 75 minutes of direct physician-patient contact.
- Use A160 when a patient with end-stage renal disease requires a comprehensive assessment of their overall management plan, including dialysis adequacy, comorbidities, and psychosocial factors, and the physician dedicates at least 75 minutes to this discussion and examination.
- A160 is appropriate for a patient referred for evaluation of refractory hypertension with suspected secondary causes, where the nephrologist spends 75 minutes performing a detailed workup and developing a management strategy.
Common Pitfalls
- Claims for A160 are frequently adjusted to A165 if start and stop times are not meticulously documented in the patient's chart, failing to meet the 75-minute direct contact requirement.
- Billing A160 when the patient has already received a comprehensive nephrology consultation (A160, C160, W160) for the same diagnosis within the preceding 12 months will result in rejection.
- Including time spent reviewing external imaging or lab reports, or dictating the consultation note, in the 75-minute calculation will lead to an audit adjustment, as only direct patient contact time is billable.
Billing Tips
- Ensure the referral request from the referring physician or NP is clearly documented in the chart before submitting the claim for A160.
- When A160 is performed virtually, append 'A' to the code (A160A) and ensure the documentation reflects a video-only encounter meeting all other A160 requirements.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Consultation
Must satisfy all elements of a consultation as defined in (written request from referring physician/NP/dental surgeon, written report back to referrer).
Minimum of 75 minutes of direct contact with the patient.
Start and stop times must be recorded in the patient's permanent medical record.
The calculation of the 75-minute minimum excludes time devoted to any other service or procedure for which an amount is payable in addition to the consultation.
The calculation of time excludes non-patient-facing time (e.g., reviewing charts, imaging, or documentation).
Age-based fee premiums apply: 30% (<30 days), 25% (30 days to <1 year), 20% (1 year to <2 years), 15% (2 years to <5 years), 10% (5 years to <16 years).
A160A is designated as a 'Video Only' virtual care service.
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