A175 – 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 who requests the opinion of a vascular surgeon due to the complexity, seriousness, or obscurity of the case. It includes the necessary assessment and a written report back to the referrer.
When to Use
- Bill A175 when a vascular surgeon receives a written request from a GP for an opinion on a complex peripheral artery disease case requiring advanced intervention.
- Use A175 for a vascular surgeon assessing a patient referred by an NP for evaluation of a rapidly expanding abdominal aortic aneurysm.
- A175 is appropriate when a dental surgeon requests a vascular opinion regarding a patient with a suspected arteriovenous malformation in the jaw.
Common Pitfalls
- Billing A175 without a documented written request from the referrer, or failing to retain a copy in the chart, is a common audit risk.
- Submitting A175 when the patient is already an inpatient in a hospital or long-term care facility; these scenarios require C175 or W175 respectively.
- Receiving a referral and performing the assessment, but then requesting the referrer to submit the formal request after the fact will lead to claim rejection.
Billing Tips
- Ensure the written report back to the referrer includes specific findings, opinions, and clear recommendations for management.
- If the consultation is for a patient under 30 days old, remember to add the appropriate age premium (e.g., AGE_PREMIUM_LT_30_DAYS) to the A175 claim.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
A. Consultations and Visits
Consultation
Written request from a referring physician, NP, or dental surgeon.
Written report (findings, opinions, and recommendations) sent to the referring physician, nurse practitioner or dental surgeon.
Performance of a general, specific or medical specific assessment, including a review of all relevant data.
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 written request sets out the information relevant to the referral and specifies the service(s) required.
Preoperative consultations for low-risk elective procedures (cataract, colonoscopy, etc.) are only eligible if medically necessary.
If consultation requirements are not met, the fee will be adjusted to a lesser assessment fee.
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