A590 – Comprehensive rheumatology consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered by a specialist in rheumatology who provides all the appropriate elements of a consultation and spends a minimum of seventy-five (75) minutes of direct contact with the patient, exclusive of time spent rendering any other separately billable intervention.
When to Use
- When a patient presents with new-onset, complex rheumatologic symptoms requiring a detailed, prolonged evaluation by a rheumatologist, exceeding 75 minutes of direct patient contact.
- When a patient requires a comprehensive assessment for suspected systemic autoimmune diseases such as lupus, rheumatoid arthritis, or scleroderma, including a thorough review of history, physical exam, and diagnostic workup.
- When a referring physician requests a specialist rheumatology opinion for a patient with unclear or refractory rheumatologic symptoms that do not fit simpler diagnoses like osteoarthritis or bursitis.
Common Pitfalls
- Billing A590 when the patient's condition is uncomplicated (e.g., osteoarthritis, bursitis) or when the direct patient contact time is less than 75 minutes, leading to adjustment to a lesser assessment fee.
- Failing to document the start and stop times of the 75-minute consultation in the patient's medical record, which is a mandatory requirement for this code.
- Submitting A590 for ongoing management of complex rheumatologic disorders; A480 is the appropriate code for subsequent complex assessments and management.
Billing Tips
- Ensure the referral request clearly states the reason for consultation and identifies the referring provider's name and OHIP billing number.
- Retain a copy of the referral in the patient's chart, unless the consultation occurs in a setting with common medical records (hospital, LTC, multi-specialty clinic).
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultation
Must satisfy all elements of a consultation as defined in the General Preamble (), including a written request from a referring physician, nurse practitioner, or dental surgeon.
A written report (including findings, opinions, and recommendations) must be prepared and sent to the referring provider.
Requires a minimum of 75 minutes of direct contact with the patient.
The start and stop times of the consultation must be recorded in the patient's permanent medical record.
Time calculation excludes time devoted to any other service or procedure for which an amount is payable in addition to the consultation.
Time calculation excludes non-patient-facing time (e.g., reviewing charts, imaging, or documentation).
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.
A consultation or assessment service may be claimed for the initial evaluation. Subsequent ongoing management of complex disorders (e.g., systemic vasculitides, inflammatory myopathies) should be billed as A480.
Eligible for age-based fee premiums for patients under 16 years of age ().
Eligible for special visit premiums if the criteria for a non-elective visit are met ().
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