A725 – Occupational Medicine - Consultation
OHIP General Listings Code · Schedule of Benefits
A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon (in connection with an insured dental procedure in a hospital). The consultant physician, competent in occupational medicine, provides an opinion due to the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient or their representative. The service includes the necessary assessment and a written report (findings, opinions, and recommendations) to the referring provider.
When to Use
- When a physician requests an occupational medicine specialist's opinion on a complex work-related injury that is impacting a patient's ability to return to their job, and the referring physician needs a detailed report for management.
- When a patient's representative requests a second opinion from an occupational medicine consultant regarding a chronic occupational illness, and a written referral is provided.
- When a nurse practitioner refers a patient with a suspected occupational exposure requiring specialized assessment and a written report back to the NP and the patient's primary care provider.
Common Pitfalls
- Billing A725 without a valid written referral from a physician, nurse practitioner, or dental surgeon, which is a primary requirement for this code.
- Failing to provide a written report to the referring provider, which is a mandatory component of the A725 service and can lead to claim rejection or audits.
- Billing A725 for a condition that has already been consulted on within the last 12 months by the same physician for the same diagnosis, unless it meets specific exceptions for repeat consultations or unrelated diagnoses.
Billing Tips
- Ensure the written referral clearly states the patient's condition, the reason for consultation, and the specific questions the referring provider needs answered by the occupational medicine specialist.
- Retain a copy of the written referral and the consultation report in the patient's chart, as these documents are crucial for audit purposes and to justify the A725 claim.
Effective: April 1, 2026
Occupational Medicine
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.
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.
A written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner or dental surgeon. Where the referral is made by a nurse practitioner, the consultant shall provide the report to the nurse practitioner and the patient’s primary care provider, if applicable.
The request would ordinarily also include appropriate clinical information, such as the reason for the referral for consultation, present and past history, physical findings and relevant test results and reports.
Preoperative consultations for low-risk elective procedures (e.g., cataract surgery, colonoscopy) are only eligible if the medical record demonstrates the consultation is medically necessary.
Consultations requested by a Medical Trainee are adjusted to a lesser assessment fee.
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