A460 – Comprehensive Infectious Disease Consultation
OHIP General Listings Code — Infectious Disease (46) · Schedule of Benefits
A comprehensive infectious disease consultation requiring a minimum of 75 minutes in direct contact with the patient, satisfying all elements of a consultation as defined in the General Preamble.
When to Use
- Use A460 for a new patient referred by a GP for a complex, undiagnosed fever of unknown origin requiring extensive history, physical, and discussion, lasting at least 75 minutes.
- Bill A460 when an HIV-positive patient requires a comprehensive assessment for management of multiple opportunistic infections and medication reconciliation, exceeding 75 minutes.
- A460 is appropriate for a patient with suspected endocarditis requiring detailed review of multiple imaging studies, microbiology reports, and prolonged direct patient contact to establish a management plan.
Common Pitfalls
- Claims for A460 are frequently reduced if the medical record does not explicitly document both the start and stop times of the 75-minute direct patient contact.
- Billing A460 when the direct patient contact time is less than 75 minutes will result in the claim being adjusted to a lesser assessment fee, such as A270.
- Failure to include a written report to the referring physician, nurse practitioner, or dental surgeon, or documentation of the referral request, can lead to claim rejection or audit.
Billing Tips
- Ensure the 75-minute minimum direct patient contact time for A460 excludes time spent reviewing external records or dictating reports; only face-to-face time counts.
- When seeing a hospital in-patient for an infectious disease consultation, use C460, which has the same time and documentation requirements as A460.
Effective: June 1, 2025
Consultations and Visits
Infectious Disease (46)
Consultations and Visits
Consultation
A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner or dental surgeon in connection with an insured dental procedure rendered in a hospital.
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.
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.
The start and stop times must be recorded in the patient’s permanent medical record or the amount payable for the service will be adjusted to a lesser paying fee.
Minimum of 75 minutes in direct contact with the patient.
The calculation of the 75-minute minimum time excludes non-patient-facing time such as time spent reviewing charts, imaging, or documentation.
Physicians in hospital but not on duty in the Emergency Department when seeing patients in the Emergency or OPD should use General Listings (A460).
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