A385 – Limited Consultation
OHIP General Listings Code — Neurology (18) · Schedule of Benefits
A limited consultation is a consultation which is less demanding and, in terms of time, normally requires substantially less of the physician’s time than the full consultation. Otherwise, it has the same requirements as a full consultation, including a written request from a referring physician, nurse practitioner, or dental surgeon, and a written report to the referring provider.
When to Use
- When a referring provider requests a focused opinion on a specific neurological symptom (e.g., transient numbness) without requiring a full neurological assessment (A113) or a comprehensive consultation (A185).
- For follow-up opinions on a previously diagnosed neurological condition where a full re-assessment is not necessary, and a simple report suffices.
- When a nurse practitioner refers a patient for a specific neurological concern that can be addressed with a brief review and report, distinct from a full consultation.
Common Pitfalls
- Billing A385 when a more comprehensive assessment code (e.g., A113, A185) is actually warranted by the complexity of the patient's condition and the physician's work.
- Failing to obtain and retain a written request from the referring provider or failing to send a written report back to the referring provider, leading to claim rejection or audit issues.
- Billing A385 for a patient already seen for the same diagnosis within the last 12 months, without meeting the exception criteria for hospital inpatients or ED patients.
Billing Tips
- Ensure the written report sent to the referring provider clearly outlines the specific findings, opinion, and recommendations related to the limited nature of the consultation.
- When billing virtually, always append the 'A' suffix (A385A) and confirm the service was conducted via video, as telephone-only consultations are not eligible.
Effective: June 1, 2025
Consultations and Visits
Neurology (18)
Consultations and Visits
Consultation
A written request signed by the referring provider must be kept in the consultant's medical record.
The request must identify the consultant, the referring provider (name and billing number), and the patient (name and health number).
The consultant must prepare a written report (findings, opinions, and recommendations) and send it to the referring provider.
If the referral is from a nurse practitioner, the report must also be sent to the patient's primary care provider if applicable.
A limited consultation is intended for cases that are less demanding and require substantially less time than a full consultation (A185).
If a physician has already been paid for a consultation for the same diagnosis and makes a request for a referral for ongoing management, subsequent services are not payable as consultations.
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