A580 – Comprehensive laboratory medicine consultation
OHIP General Listings Code · Schedule of Benefits
A consultation rendered by a specialist in laboratory medicine 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
- When a pathologist provides a comprehensive review of complex diagnostic findings, requiring at least 75 minutes of direct patient contact, and a detailed written report is issued to the referring physician.
- For a specialist in laboratory medicine to provide a full consultation on a patient's diagnostic workup, including interpretation of multiple specialized tests and direct patient discussion, exceeding 75 minutes.
- When a patient requires an in-depth interpretation of genetic testing results or complex molecular diagnostics, necessitating a prolonged direct consultation with a laboratory medicine specialist.
Common Pitfalls
- Billing A580 when the direct patient contact time is less than 75 minutes; this may lead to payment adjustment to a lesser fee code like A285.
- Failing to document the start and stop times of the patient encounter in the medical record, which is a mandatory requirement for this code.
- Submitting A580 when a consultation for the same diagnosis has been billed within the last 24 months, which would be more appropriately billed as A586 if criteria are met.
Billing Tips
- Ensure the written report sent to the referring provider includes findings, opinions, and specific recommendations, as this is a key component of the consultation.
- Verify that the referral request clearly identifies the patient, referring provider (with billing number), and the specific service required, and retain a copy in your records unless a common record exists.
Effective: April 1, 2026
Laboratory Medicine
Consultation
Must satisfy all elements of a consultation as defined in General Preamble .
Requires a written request from a referring physician, nurse practitioner, or dental surgeon.
Minimum of 75 minutes in direct contact with the patient.
Start and stop times must be recorded in the patient’s permanent medical record.
A written report (including findings, opinions, and recommendations) must be sent to the referring provider.
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.
The calculation of time excludes time devoted to any other service or procedure for which an amount is payable in addition to the consultation.
The calculation of time excludes non-patient-facing time (e.g., chart review, imaging review, documentation).
Eligible for age-based fee premiums for patients under 16 years of age ().
Note: The SOB table on page A131 contains a typo listing the description as 'Comprehensive internal medicine consultation'; however, the heading and commentary confirm it is a Laboratory Medicine service.
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