A188 – 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: 1. the following diseases of the neuromuscular system a. generalized peripheral neuropathies; b. myopathies; c. diseases of the neuromuscular junction; or d. diseases of the motor neurone. 2. the following chronic central nervous system disorders: a. Malignant neoplasms (brain) b. Psychosomatic disturbances (functional neurological disorder) c. Chronic migraine or trigeminal autonomic cephalalgias d. Huntington’s chorea e. Trigeminal neuralgia f. Intracranial hemorrhage g. Stroke
When to Use
- Bill A188 for a 30-minute follow-up visit with a patient diagnosed with Huntington's chorea, focusing on medication management and symptom progression.
- Use A188 for a new patient consultation presenting with generalized peripheral neuropathy and significant motor weakness, requiring a detailed neurological examination and management plan.
- Bill A188 for a patient with a documented history of stroke and ongoing central nervous system deficits, requiring a 25-minute assessment of their recovery and functional status.
Common Pitfalls
- Billing A188 for a routine follow-up of a stable chronic condition like well-controlled epilepsy, which does not meet the complexity or 20-minute direct contact requirement.
- Submitting A188 when the primary focus of the visit is psychotherapy or counselling, as these services are restricted on the same day unless distinct diagnoses are clearly documented.
- Failing to document the minimum 20 minutes of direct patient contact for A188, or including time spent on separately billable procedures in the visit duration.
Billing Tips
- Ensure the patient's diagnosis clearly falls under the specified chronic neurological conditions (e.g., myopathy, chronic migraine, stroke sequelae) to justify the use of A188.
- Consider the E078 Chronic Disease Assessment Premium if the A188 is performed by a neurologist in an office or hospital outpatient clinic for an eligible chronic condition, provided all criteria are met.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments
Appropriate medical records must be kept, establishing that an insured service was provided, the service claimed is the service rendered, and the service was medically necessary.
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.
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