A180 – Special neurology consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A complex neurological assessment is an assessment for the ongoing management of the following complex chronic neurological conditions where the complexity of the condition requires the continuing management by a neurologist and where the visit requires a minimum of 20 minutes in direct contact with the patient, exclusive of time spent rendering any other separately billable intervention to the patient.
When to Use
- Bill A180 for a patient with newly diagnosed Huntington's chorea requiring a detailed neurological assessment and management plan, provided a referral is present and the visit exceeds 20 minutes.
- Use A180 for a patient with a documented generalized peripheral neuropathy experiencing significant functional decline, necessitating a comprehensive neurological re-evaluation and management strategy.
- A180 is appropriate for a patient with a history of stroke who presents with new, complex neurological deficits requiring specialist assessment and a detailed report to the referring physician.
Common Pitfalls
- Claims for A180 are frequently rejected if the minimum 20 minutes of direct patient contact is not met or if start/stop times are not documented in the chart.
- Billing A180 without a valid written referral from a physician, NP, or dental surgeon is a common reason for claim rejection.
- Failure to send a written report to the referring provider can lead to payment adjustments or audits for A180 claims.
Billing Tips
- Ensure the patient's diagnosis aligns strictly with the complex chronic neurological conditions listed in the A180 description to avoid claim denials.
- Remember that A180 has usage limits: one per two years for the same diagnosis and one per year for an unrelated diagnosis; track these to prevent overbilling.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultation
Minimum 20 minutes of direct patient contact
Written request from a referring physician, NP, or dental surgeon
Written report to the referring provider
Start and stop times must be recorded in the medical record
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
Time spent on separately billable interventions cannot be counted toward the 20-minute minimum.
If time requirements or documentation requirements (start/stop times) are not met, the fee is adjusted to a lesser assessment.
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