A465 – Infectious Disease Consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered by an infectious disease specialist following a written request from a referring physician, nurse practitioner, or dental surgeon. The service includes a comprehensive assessment, review of relevant data, and a written report to the referrer.
When to Use
- Bill A465 for an initial outpatient consultation requested by a family physician for a patient with a new diagnosis of HIV requiring specialist management advice.
- Use A465 when a dentist refers a patient with a complex oral infection requiring systemic treatment and specialist input.
- A465 is appropriate for a nurse practitioner's referral of a patient with a suspected tick-borne illness needing expert diagnostic and treatment guidance.
Common Pitfalls
- Claims for A465 are frequently adjusted to a lesser fee if start and stop times are not meticulously recorded in the patient's chart.
- Failure to obtain and retain a written request from the referring provider (physician, NP, or dentist) will lead to claim rejection or adjustment.
- Submitting A465 for a patient already seen for the same infectious disease within the last 12 months, without a clearly unrelated new diagnosis, will be denied.
Billing Tips
- Ensure the written report sent to the referrer includes specific findings, opinions, and actionable recommendations to support the consultation service.
- If the consultation extends beyond 75 minutes of direct patient contact, consider billing A460 instead of A465.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Specialist Consultation
Consultation
A written request from the referring provider must be kept in the consultant's medical record.
A written report (including findings, opinions, and recommendations) must be sent to the referring provider.
The start and stop times must be recorded in the patient’s permanent medical record or the amount payable will be adjusted to a lesser paying fee.
The consultant must perform a general, specific, or medical specific assessment, including a review of all relevant data.
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.
For patients aged 17 years and over. Use <billingCode>A765</billingCode> for patients 16 years of age and under.
Start and stop times are mandatory for the full fee to be payable.
For hospital in-patients seen in the Emergency or OPD when the physician is not on duty, use General Listings (A465).
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