A184 – Complex neurological assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A complex neurological assessment is an assessment for the ongoing management of specific 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.
When to Use
- Bill A184 for a follow-up visit for a patient with Huntington’s chorea requiring ongoing management and adjustment of medication, provided the visit exceeds 20 minutes of direct patient contact.
- Use A184 when managing a patient with a chronic neuromuscular disease like myasthenia gravis, and the visit involves a detailed neurological examination and discussion of treatment options, lasting at least 20 minutes.
- A184 is appropriate for a patient with a history of stroke who presents for ongoing management of neurological deficits, including assessment of mobility and cognitive function, with a minimum 20-minute direct interaction.
Common Pitfalls
- Billing A184 for uncomplicated neurological conditions like carpal tunnel syndrome or Bell's palsy, which are not considered complex chronic neurological conditions.
- Failing to document the start and stop times of the 20-minute direct patient contact, which can lead to fee adjustments to a lesser-paying code like A188.
- Exceeding the limit of two A184 claims per patient per physician within a 12-month period, unless the patient is admitted to the hospital.
Billing Tips
- Ensure the 20-minute direct patient contact time for A184 excludes time spent on other separately billable procedures or interventions.
- A184 can be billed with the E078 Chronic disease assessment premium if the patient has an established chronic disease documented in their chart and the visit meets all other criteria for both codes.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Medical specific re-assessment
Assessment
Requires a minimum of 20 minutes in direct contact with the patient.
Time spent on other separately billable interventions must be excluded from the 20-minute minimum.
The start and stop times of the service must be recorded in the patient's permanent medical record.
The assessment must be for the ongoing management of a complex chronic neurological condition.
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