A165 – Nephrology Consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered by a specialist in nephrology following a written request from a referring physician, nurse practitioner, or dental surgeon. The service includes the necessary assessment (general, specific, or medical specific) and a written report back to the referring provider.
When to Use
- Bill A165 for a new patient referral from a family physician for unexplained proteinuria, where a comprehensive assessment and written report are provided.
- Use A165 when a nurse practitioner refers a patient with suspected early-stage diabetic nephropathy requiring specialist evaluation and management recommendations.
- Bill A165 for a patient presenting with new-onset hypertension and declining renal function, requiring a nephrology consultation and a report to the referring physician.
Common Pitfalls
- Do not bill A165 if the patient is already managed under the Chronic Dialysis Team Fee (G860-G865) for dialysis-related issues, as this code is included in the team fee.
- Avoid billing A165 for in-patients; use C165 for non-emergency hospital in-patient consultations instead.
- Ensure a written request for consultation is documented in the chart, unless the patient is in a hospital, LTC, or multi-specialty clinic with common records.
Billing Tips
- If the consultation requirements (written request/report) are not met, the fee may be adjusted to a lesser assessment fee, so always ensure documentation is complete.
- For consultations requiring a minimum of 75 minutes of direct patient contact, consider billing A160 (Comprehensive Nephrology Consultation) instead of A165.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
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. In such cases, the written request may be contained on the common medical record.
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 consultant is required to perform a general, specific or medical specific assessment, including a review of all relevant data.
Patient aged 17 years or older
If the consultation requirements (written request/report) are not met, the fee will be adjusted to a lesser assessment fee.
Preoperative consultations for low-risk elective procedures (e.g., cataracts, colonoscopy) are only eligible if medically necessary and documented as such.
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