A745 – Not found
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A limited consultation is a consultation which is less demanding and, in terms of time, normally requires substantially less of the physician’s time than the full consultation. Otherwise, a limited consultation has the same requirements as a full consultation.
When to Use
- Use A745 for a referral for a specific, non-urgent issue that requires a consultant's opinion but not a full workup, such as a brief assessment of a stable rash.
- Bill A745 when a patient is referred for a second opinion on a clearly defined, stable condition that has not changed significantly since the initial assessment.
- This code is appropriate when a referring physician requests a consultant's input on a specific aspect of a patient's care, and the consultant's assessment is expected to be brief and focused.
Common Pitfalls
- Billing A745 when the service provided is more complex and warrants a full consultation (A345), leading to potential claim rejection or audit.
- Failure to obtain and retain a written referral from a physician, NP, or dental surgeon, which is a mandatory requirement for A745.
- Not sending a written report of findings, opinions, and recommendations back to the referring provider, which is a key documentation requirement for A745.
Billing Tips
- Ensure the referral specifies the information required and the services needed to justify the limited nature of the consultation.
- Remember that A745 is not payable with E078 (Chronic disease assessment premium); E078 is only payable with specific assessment codes.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Consultation
A written request from the referring provider must be signed and kept in the consultant's medical record.
The request must identify the consultant, the referring provider (name and billing number), and the patient (name and health number).
The request must specify the information relevant to the referral and the services required.
The consultant must prepare a written report (findings, opinions, and recommendations) to the referring provider.
The consultant must perform a general, specific, or medical specific assessment, including a review of all relevant data.
A745 is eligible for Special Visit Premiums (Travel and First Person Seen) when rendered in qualifying locations (ED, OPD, In-patient, LTC, Home, or Office) under non-elective circumstances or sacrifice of office hours.
The time at which the special visit takes place must be documented on the medical record to claim special visit premiums.
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