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A425
A425 – Comprehensive physical medicine and rehabilitation consultation
OHIP Consultations and Visits Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A comprehensive physical medicine and rehabilitation consultation is a consultation in which the physician provides all the elements of a consultation and spends a minimum of 75 minutes in direct contact with the patient, exclusive of time spent rendering any other separately billable intervention to the patient.
Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon
The physician must provide all elements of a consultation (history, examination, review of relevant data).
Minimum of 75 minutes in direct contact with the patient.
The start and stop time must be recorded in the patient’s permanent medical record.
A written report (including findings, opinions, and recommendations) must be prepared and sent to the referring provider.
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.
Usage limits
Limited to one every 2 years by the same physician.
Calculation of time excludes non-patient-facing time such as time spent reviewing charts, imaging, or documentation.
If consultation requirements are not met, the amount payable will be reduced to a lesser assessment fee.
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