A435 – Limited Consultation
OHIP General Listings Code — Internal and Occupational Medicine (13) · Schedule of Benefits
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, a limited consultation has the same requirements as a full consultation.
When to Use
- Use A435 for a focused assessment of a specific symptom or condition, such as evaluating a new rash or a brief episode of dizziness, where a full history and physical exam (as in A135) is not warranted.
- Bill A435 when a patient is referred for a specific, limited question, like assessing the suitability for a particular procedure, and the consultant's opinion is confined to that narrow scope.
- A435 is appropriate for a follow-up assessment of a previously diagnosed condition where the physician is only addressing a new, isolated complication or question, distinct from a repeat consultation (A136).
Common Pitfalls
- Billing A435 when the service provided was a comprehensive assessment or a full consultation (A135), leading to claim rejection or audit adjustments.
- Failure to obtain and retain a valid written referral from a physician, NP, or dental surgeon, or if the referral lacks necessary details, can result in the claim being adjusted to A133.
- Billing A435 for a service that is essentially a follow-up visit for an ongoing management issue, which may be better captured by other visit codes or not billable as a consultation.
Billing Tips
- Ensure the consultation report clearly addresses the specific question asked in the referral and is sent to the referring provider within the required timeframe.
- Remember that A435 is not payable on the same day as other consultations or assessments by the same physician, except in specific circumstances outlined in the OHIP Schedule.
Effective: June 1, 2025
Consultations and Visits
Internal and Occupational Medicine (13)
Limited Consultation
Consultation
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.
A consultation includes the services necessary to enable the consultant to prepare a written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner or dental surgeon. Where the referral is made by a nurse practitioner, the consultant shall provide the report to the nurse practitioner and the patient’s primary care provider, if applicable.
Except where otherwise specified, the consultant is required to perform a general, specific or medical specific assessment, including a review of all relevant data.
Eligible for age-based premiums for patients under 16 years of age.
A435A is designated as 'Video Only' in Appendix J.
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