A470 – Comprehensive respiratory disease consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered by a specialist in respiratory disease who provides all the appropriate 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.
When to Use
- Bill A470 when managing a patient with severe, complex, or multiple co-existing respiratory conditions (e.g., advanced COPD with pulmonary hypertension and interstitial lung disease) requiring extensive history, examination, and discussion over a minimum of 75 minutes.
- Use A470 for a new patient referral requiring a comprehensive workup for undiagnosed, complex respiratory symptoms that cannot be adequately addressed in a shorter consultation like A475.
- Consider A470 for a patient with a rare or refractory respiratory disease where a specialist's in-depth assessment and management plan, exceeding 75 minutes, is necessary.
Common Pitfalls
- Billing A470 when the direct patient contact time is less than 75 minutes, which will likely result in the claim being adjusted to a lesser assessment code like A475 or A473.
- Failing to exclude time spent on other separately billable procedures or non-patient-facing activities from the 75-minute calculation, leading to potential claim rejection or adjustment.
- Not obtaining and documenting a valid written request from a referring physician, NP, or dental surgeon, or not sending a comprehensive written report back to the referring provider, as these are mandatory requirements for A470.
Billing Tips
- Meticulously record the start and stop times of the patient encounter in the medical record to substantiate the 75-minute minimum requirement for A470.
- Ensure the referral request and the final report clearly outline the complexity of the respiratory disease and the extensive nature of the assessment, justifying the use of A470 over other consultation codes.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultation
Must satisfy all the elements of a consultation as defined in the General Preamble (), including a written request from a referring physician, nurse practitioner, or dental surgeon, and a written report to the referring provider.
Minimum of 75 minutes in direct contact with the patient.
The start and stop times must be recorded in the patient’s permanent medical record.
Calculation of time excludes time devoted to any other service or procedure for which an amount is payable in addition to the consultation.
Calculation of time excludes non-patient-facing time (e.g., time spent reviewing charts, imaging, or documentation).
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.
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