A192 – Consultative interview - patient 65+ or with dementia
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Consultative interview on behalf of disturbed patient (including report) - consultative interview with patient at least 65 years of age, or a patient less than 65 years of age with a diagnosis of dementia
When to Use
- Bill A192 when a patient over 65, or under 65 with a documented dementia diagnosis, presents with significant cognitive, emotional, or behavioral disturbances impacting their ability to provide a reliable history.
- Use A192 for a consultative interview where the physician reviews all relevant patient data, performs an assessment, and prepares a detailed report for the referring provider.
- A192 is appropriate when the primary purpose is a consultative interview for a 'disturbed patient' as defined, not for routine follow-up or management of stable conditions.
Common Pitfalls
- Submitting A192 without a clear report detailing findings, opinions, and recommendations sent to the referring physician will lead to rejection.
- Billing A192 for patients who do not meet the 'disturbed patient' criteria or lack the required age/dementia diagnosis will result in claim denial.
- Attempting to bill A192 on the same day as K191, K193, K195, K196, or K001 will cause the claim to be rejected due to same-day restrictions.
Billing Tips
- Ensure the patient's chart clearly documents the assessment, the 'disturbed patient' criteria met, and the specific details of the consultative interview, as this forms the basis for the report.
- When extending the consultation with K630, meticulously track time spent in direct patient/caregiver contact beyond the initial A192 service, ensuring the minimum 60 minutes for A192 is met before billing K630.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultative Interview
Consultations, Interviews
The physician must perform a general, specific, or medical specific assessment, including a review of all relevant data.
A written report (including findings, opinions, and recommendations) must be prepared and sent to the referring provider.
The patient must meet the definition of a 'disturbed patient': someone experiencing a clinically significant disturbance in cognition, emotional regulation, or behavior which limits their ability to provide a reliable and complete history.
Patient is at least 65 years of age, OR patient is less than 65 years of age with a diagnosis of dementia
A192 is classified as a consultation.
Time spent on other separately billable interventions must be excluded from the time calculation for extensions.
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