A545 – Limited consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation which is less demanding and requires substantially less time than a full consultation, rendered by a Gastroenterology specialist following a written request from a referring provider.
When to Use
- Use A545 for a gastroenterologist to provide a focused opinion on a specific issue, such as interpreting a single diagnostic test result, when a full consultation (A415) is not warranted.
- Bill A545 when a referring provider requests a specialist's input on a patient with a specific diagnosis like GERD (530.81) or IBS (558.9), and the scope of the consultation is limited.
- A545 is appropriate when a patient requires a brief assessment for a known condition, such as a follow-up on medication efficacy for peptic ulcer disease (531-533), after the initial workup is complete.
Common Pitfalls
- Billing A545 when the service provided meets the criteria for a full consultation (A415), leading to potential under-billing or claim rejection.
- Failure to include a written report back to the referring provider, which is a mandatory requirement for A545 and can lead to payment reduction or audit issues.
- Submitting A545 for a patient already seen for the same diagnosis within the last 12 months, unless the diagnosis is unrelated, violating the usage limits.
Billing Tips
- Ensure the written request clearly specifies the limited nature of the consultation and the specific question being asked by the referring provider.
- When A545 is performed on the same day as a colonoscopy (A120), ensure the documentation clearly delineates the services provided for each code to avoid same-day billing conflicts.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Gastroenterology
Consultation
Written request from a referring physician, nurse practitioner, or dental surgeon.
Written report back to the referring provider including findings, opinions, and recommendations.
Medical record must contain the signed request and the report.
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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