A645 – Medical Specific Assessment - General Thoracic Surgery
OHIP General Listings Code — General Thoracic Surgery (64) · Schedule of Benefits
A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon (for hospital-based dental procedures). The consultant physician, competent in General Thoracic Surgery, provides an opinion on a case due to its complexity, seriousness, or obscurity. The service includes the necessary elements to prepare a written report (findings, opinions, and recommendations) back to the referrer.
When to Use
- Bill A645 when a referring physician requests your expert opinion on a complex case of suspected lung cancer requiring surgical evaluation, and you provide a detailed written report.
- Use A645 for a patient referred by a GP for pre-operative assessment of a large mediastinal mass requiring thoracic surgery, where you conduct a thorough assessment and document your findings and recommendations.
- A645 is appropriate when a thoracic surgeon is consulted for a second opinion on a severe empyema case unresponsive to initial medical management, necessitating a surgical plan.
Common Pitfalls
- Submitting A645 without a written request from the referring physician or without sending a written report back to the referrer will result in payment adjustment to A643.
- Billing A645 for a routine follow-up visit that does not involve a new written referral and a distinct assessment of a complex issue will be rejected.
- Claiming A645 when the service provided is a direct surgical procedure or a simple follow-up post-surgery, which should be billed under different codes like A935 if the time threshold is met.
Billing Tips
- Ensure the written request clearly states the reason for the consultation and the specific questions to be addressed by the thoracic surgeon.
- If the consultation is performed virtually via video, append 'A' to the code (A645A) to indicate a virtual service.
Effective: June 1, 2025
Consultations and Visits
General Thoracic Surgery (64)
Consultations and Visits
Consultation
Written request identifying the consultant, referrer, and patient, and specifying the reason for referral.
Written report including findings, opinions, and recommendations sent to the referrer.
The consultant must perform a general, specific, or medical specific assessment as part of the consultation.
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.
If the consultation is requested by a Medical Trainee, the fee is adjusted to a lesser assessment fee.
Consultations for low-risk elective procedures (e.g., cataract surgery, colonoscopy) are only eligible if medically necessary and documented as such.
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