A682 – Complex neurological assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation in which the neurologist provides all elements of a consultation (A185) and spends a minimum of 90 minutes in direct contact with the patient, exclusive of time spent rendering any other separately billable intervention.
When to Use
- When a patient requires an extensive neurological workup for a newly diagnosed, complex condition like amyotrophic lateral sclerosis (ALS) or a challenging epilepsy case, necessitating a full 90 minutes of direct patient contact.
- For a patient with a rare neurological disorder previously managed elsewhere, requiring a comprehensive re-evaluation and detailed management plan that extends beyond the typical consultation time.
- When a patient presents with multiple, overlapping neurological symptoms (e.g., severe migraine with aura, concurrent peripheral neuropathy, and cognitive decline) that demand a prolonged, in-depth assessment.
Common Pitfalls
- Billing A682 when the direct patient contact time is less than 90 minutes; this should be downgraded to A180 or A185.
- Including time spent on separately billable procedures (e.g., EMG, nerve conduction studies) or non-patient-facing chart review in the 90-minute calculation.
- Failing to document the start and stop times of the patient encounter in the medical record, which can lead to fee adjustments or audits.
Billing Tips
- Ensure the referral clearly indicates the complexity of the neurological issue, justifying the need for an extended assessment.
- Confirm that all elements of a standard consultation (A185) are covered within the 90-minute direct patient contact, as A682 includes these components.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Time-based
Consultation
Written request from a referring physician, nurse practitioner, or dental surgeon.
Written report to the referring provider.
Minimum 90 minutes of direct patient contact.
Start and stop times must be recorded in the medical record.
Calculation of time excludes non-patient-facing time (e.g., chart review).
Calculation of time excludes time spent on other separately billable procedures.
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