A223 – Extended special genetic consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Extended special genetic consultation is a consultation in which the physician provides all the elements of a consultation (A225) and spends a minimum of 90 minutes in direct contact with the patient with or without family, exclusive of time spent rendering any other separately billable intervention to the patient.
When to Use
- When a patient requires a comprehensive genetic assessment for a complex inherited condition, necessitating a minimum of 90 minutes of direct physician-patient interaction.
- For genetic consultations involving extensive family history review and counseling for multiple affected relatives, exceeding the time requirements of A220 (75 minutes) or A225 (standard consultation).
- When a patient presents with a rare genetic disorder requiring detailed explanation of inheritance patterns, prognosis, and management options, and the physician spends over 90 minutes directly with the patient and/or family.
Common Pitfalls
- Billing A223 when the direct patient contact time is less than 90 minutes; this should be billed as A225 (Genetic Consultation) or A220 (Special genetic consultation) if between 75-89 minutes.
- Failing to obtain and retain a written request from the referring physician, nurse practitioner, or dental surgeon, which is a mandatory requirement for this code.
- Including time spent reviewing external reports or imaging, or time spent documenting the encounter, in the 90-minute direct patient contact calculation, as only direct patient interaction is billable.
Billing Tips
- Ensure the written report to the referring provider includes detailed findings, opinions, and specific recommendations, as this is a key component of the consultation.
- Accurately record the start and stop times of the 90-minute direct patient contact in the patient's medical record to substantiate the billing of A223.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Genetics
Consultation
Must be rendered following a written request from a referring physician, nurse practitioner, or dental surgeon (for hospital-based insured dental procedures).
The consultant must provide a written report (including findings, opinions, and recommendations) to the referring provider.
The physician must spend a minimum of 90 minutes in direct contact with the patient (with or without family).
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.
If the requirements for a consultation (e.g., written request, report) are not met, the fee will be reduced to a lesser assessment fee.
Medically necessary consultations for low-risk elective surgeries (e.g., cataract, colonoscopy) are uncommon and must be clearly documented.
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