A185 – Complex neurological assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation is an assessment rendered by a neurologist following a written request from a referring physician, nurse practitioner, or dental surgeon. The neurologist provides an opinion and advice due to the complexity, seriousness, or obscurity of the patient's condition. The service includes a general, specific, or medical specific assessment and the preparation of a written report containing findings, opinions, and recommendations.
When to Use
- Bill A185 for an initial neurological assessment requested by a primary care physician for a patient presenting with new-onset seizures, requiring a comprehensive workup and management plan.
- Use A185 when a neurologist is consulted by a dentist for a patient with complex facial pain and suspected trigeminal neuralgia, necessitating a detailed neurological examination and report.
- A185 is appropriate for a referral from a nurse practitioner for a patient with progressive motor weakness and suspected amyotrophic lateral sclerosis (ALS), requiring specialized neurological opinion.
Common Pitfalls
- Failure to obtain and retain a written referral from a physician, NP, or dental surgeon will result in the claim being reduced to a lesser assessment fee, not the full A185 amount.
- Submitting A185 without a corresponding written report sent to the referring provider is a common reason for claim rejection or audit adjustments.
- Billing A185 for a patient already seen for the same diagnosis within the last 12 months, without meeting the exception criteria (e.g., inpatient status), will lead to denial.
Billing Tips
- Ensure the written report accompanying A185 clearly outlines findings, opinions, and specific recommendations to the referring provider.
- For virtual consultations, remember to append 'A' to the code (A185A) and confirm the encounter was video-based, as telephone-only is not eligible.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Consultation
Written request identifying the consultant, referrer, and patient, and specifying the service required.
Performance of a general, specific, or medical specific assessment, including a review of all relevant data.
A written report must be sent to the referring physician or nurse practitioner.
The request and report must be maintained in the patient's 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, 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.
A written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner or dental surgeon. Where the referral is made by a nurse practitioner, the consultant shall provide the report to the nurse practitioner and the patient’s primary care provider, if applicable.
If consultation requirements (request/report) are not met, the fee is reduced to a lesser assessment fee.
Age-based premiums apply for patients under 16 years of age (10% to 30% increase).
A185 is the base consultation code for Neurology; time-based consultations (A180, A682) are built upon its requirements.
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