All codes
A585
A585 – Diagnostic Consultation
OHIP General Listings Code — Laboratory Medicine (28) · Schedule of Benefits
A diagnostic laboratory medicine consultation is the service rendered when tissue, slides, specimens and/or laboratory results prepared in one licensed laboratory are referred to a laboratory medicine physician not in the same licensed laboratory for a written opinion.
When to Use
- Bill A585 when a pathologist in one licensed laboratory reviews slides prepared by a different licensed laboratory and provides a written interpretation.
- Use A585 for a referral of a complex biopsy result from an external facility to your laboratory's specialist for a second opinion and written report.
- A585 is appropriate when a physician refers a tissue specimen to a different licensed laboratory for a specialized diagnostic interpretation by a laboratory medicine physician.
Common Pitfalls
- Billing A585 when the specimen was prepared and interpreted within the same licensed laboratory; this scenario would not meet the 'different licensed laboratory' requirement.
- Failing to include a written interpretative report with the claim submission, which can lead to reduced payment to a lesser assessment fee.
- Submitting A585 for comparison of results from your own lab with external results; A585 is for interpretation of externally prepared materials only.
Billing Tips
- Ensure the referring physician's request and your written interpretative report are clearly documented and available upon request to support the A585 claim.
- Verify that the specimen or results originated from a laboratory distinct from your own to meet the core requirement of A585.
Provider Fee$0.00
Specialist Fee$73.30
Effective: June 1, 2025
Category
Consultations and Visits
Subcategory
Laboratory Medicine (28)
Service Type
Laboratory Medicine
Code Classes
Consultation
Referral RequiredFrom: Physician, NursePractitioner, DentalSurgeon
Requires a written interpretative report of the procedure to the referring provider.
The consultant must be in a different licensed laboratory than the one where the specimens/results were prepared.
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