A190 – Special psychiatric consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Special psychiatric consultation is a consultation in which the physician provides all the elements of a consultation (A195) and spends a minimum of 75 minutes in direct contact with the patient, exclusive of time spent rendering any other separately billable intervention to the patient.
When to Use
- Bill A190 when a patient requires a comprehensive psychiatric assessment and management plan for a complex, treatment-resistant condition, necessitating at least 75 minutes of direct physician-patient contact.
- Use A190 for an initial psychiatric evaluation of a patient with a new diagnosis of a severe mental illness, where extensive history taking, mental status examination, and initial treatment planning are required.
- A190 is appropriate for a detailed psychiatric assessment of a patient presenting with multiple comorbidities or significant psychosocial stressors impacting their mental health, requiring prolonged direct interaction.
Common Pitfalls
- Billing A190 when the direct patient contact time is less than 75 minutes; this should be billed as a standard psychiatric consultation (A195) if other criteria are met.
- Failing to obtain and retain a written request from a referring physician, NP, or dental surgeon, which is mandatory for A190 and can lead to claim rejection.
- Submitting A190 for patients seen in a hospital, LTC, or multi-specialty clinic where common medical records are maintained, as A895, C190, or W190 may be more appropriate depending on the setting and specific circumstances.
Billing Tips
- Ensure the patient's medical record clearly documents the start and stop times of the 75+ minute direct patient contact, as this is a key requirement for A190.
- Verify that a comprehensive written report detailing findings, opinions, and recommendations is sent to the referring provider; failure to do so may result in payment adjustment to a lesser assessment fee.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Psychiatry
Consultations, Psychotherapy, Psychiatric and Counselling Services
Must provide all elements of a consultation (A195), including a general, specific, or medical specific assessment and a review of all relevant data.
Requires a written request from a referring physician, nurse practitioner, or dental surgeon.
Requires a written report (findings, opinions, and recommendations) to the referring provider.
Minimum of 75 minutes in direct contact with the patient.
Start and stop times of the service must be recorded in the patient’s permanent 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.
Time calculation excludes time devoted to any other separately billable service and non-patient-facing time (e.g., chart review, documentation).
If consultation requirements (e.g., written request/report) are not met, the fee will be adjusted to a lesser assessment fee.
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