A215 – Limited consultation for acute pain management in association with special visit to hospital in-patient
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A limited consultation for acute pain management is a consultation which takes place when a physician is requested by another physician to see a hospital in-patient because of the complexity or severity of the acute pain condition. This specific code (A215) is used when the service is rendered in association with a special visit premium.
When to Use
- Bill A215 when you are consulted by another physician for a complex post-operative pain issue in a hospital in-patient, and you are claiming a special visit premium (e.g., C960, C990).
- Use A215 if a hospital in-patient requires urgent assessment for severe acute pain, necessitating a special visit, and the assessment is limited to pain management.
- A215 is appropriate when a nurse practitioner requests a consultation for a hospital in-patient with a severe acute pain condition, and a special visit premium is applicable.
Common Pitfalls
- Billing A215 when a special visit premium is not claimed; use C215 instead for standard in-patient consultations.
- Submitting A215 for routine post-operative pain management, which is considered part of the global surgical package or covered by other visit codes.
- Claiming A215 for a pre-anaesthetic evaluation, as this is explicitly excluded and covered by other mechanisms, including the Public Hospitals Act requirements.
Billing Tips
- Always append the appropriate special visit premium code (e.g., C960, C990) to A215 on the claim submission.
- Ensure the consultation report clearly details the complexity or severity of the acute pain and the recommendations provided to the referring physician.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Anaesthesia (01)
Consultation
The consultant must provide a written report (findings, opinions, recommendations) to the referring provider.
The request must identify the consultant, referring provider, and patient by name and billing/health numbers.
The medical record must document the time at which the special visit took place.
A215 is the 'General Listing' version of the acute pain consultation, used in conjunction with premiums as per .
The routine pre-anaesthetic evaluation does not constitute a consultation regardless of setting.
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