A231 – Neuro-ophthalmology consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered by an ophthalmologist with fellowship training in neuro-ophthalmology for a patient with a neuro-ophthalmological disorder, requiring specific documented examination elements.
When to Use
- Bill A231 when an ophthalmologist with neuro-ophthalmology fellowship training evaluates a patient with optic neuritis, documented with a detailed pupillary exam, fundus exam, and visual field analysis.
- Use A231 for a patient referred for evaluation of unexplained visual field defects, requiring a neurological examination and analysis of diagnostic imaging.
- A231 is appropriate for a patient presenting with diplopia due to suspected cranial nerve palsy, necessitating a detailed extraocular motility exam and ocular alignment testing.
Common Pitfalls
- Failure to document at least four specific examination elements (e.g., pupillary exam, motility, neurological exam, fundus exam, visual fields, imaging analysis) will lead to rejection or adjustment to A235.
- Billing A231 without a valid written referral from a physician, NP, or dental surgeon, or if the referral lacks essential patient and provider details, is a common rejection reason.
- Submitting A231 for a patient without a confirmed neuro-ophthalmological disorder, or when the referral is not specifically for neuro-ophthalmology, should be billed as A235 instead.
Billing Tips
- Ensure the report to the referring provider includes specific findings, opinions, and recommendations related to the neuro-ophthalmological disorder.
- Verify that the patient's diagnosis aligns with a neuro-ophthalmological disorder to justify the use of A231 over the general consultation code A235.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Consultation
A written request from a referring physician, nurse practitioner, or dental surgeon must be kept in the consulting physician’s medical record (unless common medical records are maintained in hospital, LTC, or multi-specialty clinic).
The request must identify the consultant by name and/or specialty, the referring provider by name and billing number, and the patient by name and health number.
The written request must set out information relevant to the referral and specify services required.
A written report (including findings, opinions, and recommendations) must be provided to the referring physician, nurse practitioner, or dental surgeon (and patient's primary care provider if NP referral).
At least four of the following must be documented as part of the examination: (a) Detailed pupillary examination (includes pharmacological testing as applicable), (b) Detailed extraocular motility examination, (c) Ocular alignment testing, (d) Partial or complete neurological examination, (e) Detailed examination of the fundus, (f) Analysis of formal visual field test(s), (g) Analysis of pertinent diagnostic imaging studies.
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