A575 – Limited consultation - respiratory disease
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A limited consultation is a consultation which is less demanding and, in terms of time, normally requires substantially less of the physician’s time than the full consultation. Otherwise, a limited consultation has the same requirements as a full consultation (written request, opinion on a complex/serious/obscure case, and a written report).
When to Use
- Billing A575 for a patient with stable COPD requiring a second opinion on a new inhaler regimen, where a full A470 or repeat A476 is not yet warranted.
- Using A575 when a patient presents with a new, uncomplicated asthma exacerbation that has resolved, and the referring physician needs an opinion on ongoing management.
- Appropriate for a patient with a minor, acute respiratory complaint (e.g., uncomplicated bronchitis) where a brief assessment and management plan are needed, distinct from a comprehensive workup (A470).
Common Pitfalls
- Billing A575 when the documentation supports a more comprehensive assessment like A470, leading to potential fee adjustments.
- Failing to obtain a written request from a physician, NP, or dental surgeon, which is a mandatory requirement for A575.
- Submitting A575 for a patient with a chronic, complex respiratory condition that requires a full consultation (A470) or a repeat consultation (A476) if within the 24-month period.
Billing Tips
- Ensure the written report clearly outlines the specific respiratory issue addressed and the recommendations provided, differentiating it from a general assessment.
- Verify that the service is not a repeat consultation within 12 months for the same diagnosis, unless the patient is an inpatient or was seen in the ED, in which case a second service is permissible between 12-24 months.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Consultation
A written request from a referring physician, nurse practitioner, or dental surgeon is required.
The consultant must provide a written report (including findings, opinions, and recommendations) to the referring practitioner.
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.
A limited consultation is intended for cases that are less demanding than a full consultation (A475).
If the requirements for a consultation (e.g., written request, report) are not met, the fee will be adjusted to a lesser assessment fee.
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