A186 – 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 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 A186 for ongoing management of a patient with Huntington's chorea who requires a detailed neurological re-assessment and management plan, provided the visit exceeds 20 minutes.
- Use A186 for a patient with a diagnosed motor neurone disease requiring a follow-up assessment to adjust their management plan, ensuring the visit meets the 20-minute direct contact requirement.
- A186 is appropriate for managing a patient with a chronic CNS disorder like a primary brain tumor, where the complexity necessitates a neurologist's ongoing care and the assessment involves a specific re-assessment of neurological status.
Common Pitfalls
- Billing A186 for the initial evaluation of a patient with a new neurological complaint; use a consultation code instead as A186 is for ongoing management.
- Failure to record start and stop times for the patient encounter in the medical record can lead to payment adjustment to a lesser fee, even if all other criteria are met.
- Claiming A186 for uncomplicated neurological conditions such as carpal tunnel syndrome or Bell's palsy, which are not considered complex chronic neurological diseases under this code's criteria.
Billing Tips
- When billing virtually, always append 'A' to the code (A186A) and ensure the encounter was conducted via video, not audio-only.
- Verify the patient's condition falls within the specified complex chronic neurological conditions list (e.g., neuromuscular diseases, chronic CNS disorders, neuro-oncology) to justify the use of A186.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Assessment
Requires a minimum of 20 minutes in direct contact with the patient, exclusive of time spent rendering any other separately billable intervention.
Must include the elements of a medical specific re-assessment.
Start and stop times must be recorded in the patient’s permanent medical record.
If start and stop times are not recorded, the amount payable will be adjusted to a lesser paying fee.
Not intended for the evaluation and/or management of uncomplicated neurological disorders (e.g., carpal tunnel syndrome, Bell’s palsy, asymptomatic diabetic neuropathy).
A consultation or assessment service should be claimed for the initial evaluation; A186 is for ongoing management.
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