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A475
A475 – Consultation - Respiratory Disease
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Consultation - Respiratory Disease
When to Use
- Bill A475 for a new patient referral presenting with persistent cough and shortness of breath, where a formal respiratory assessment is required to establish a diagnosis and management plan.
- Use A475 when a patient with a known respiratory condition requires a second opinion on their management from a respirologist, provided it meets the usage limits and is not a repeat consultation (A476).
- A475 is appropriate for a patient referred for evaluation of abnormal chest imaging findings suggestive of a significant respiratory issue, requiring specialist interpretation and recommendations.
Common Pitfalls
- Billing A475 without a documented written request from the referring physician or a copy of the report sent back to the referring physician will lead to claim rejection or adjustment.
- Submitting A475 for a patient under 17 years of age; these cases should be billed using A765, not A475.
- Billing A475 when the service provided is a follow-up assessment for the same respiratory diagnosis within a 12-month period, unless the patient is an inpatient or in the ED, which may require billing A476 instead.
Billing Tips
- Ensure the patient's chart clearly indicates the written request for consultation and includes the signed report detailing findings and recommendations to the referring practitioner.
- Verify that the patient is 17 years or older; if younger, consider A765 for paediatric consultations.
Provider Fee$0.00
Specialist Fee$175.55
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Consultation
Code Classes
Consultation
Age Restriction
Patient must be 17 years of age or older. For patients 16 years of age and under, see A765.
For services not listed in the Respiratory Disease section, refer to the Internal Medicine Section.
If the requirements for a consultation are not met (e.g., no written request or report), the fee will be adjusted to a lesser assessment fee.
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