A835 – Comprehensive nuclear medicine consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A comprehensive nuclear medicine consultation is a consultation rendered by a specialist in nuclear medicine who provides all the appropriate elements of a consultation and spends a minimum of 75 minutes in direct contact with the patient, exclusive of time spent rendering any other separately billable intervention to the patient.
When to Use
- When a nuclear medicine specialist provides a comprehensive assessment and management plan for a complex patient requiring detailed interpretation of multiple nuclear medicine studies, exceeding the scope of a standard A635 consultation.
- When a patient requires a prolonged, in-depth discussion (minimum 75 minutes) covering diagnostic findings, treatment options, and prognosis related to a complex nuclear medicine diagnosis, necessitating a higher level of service than a standard A735 diagnostic consultation.
- When a specialist performs a comprehensive review of a patient's nuclear medicine history, including prior imaging, lab results, and clinical status, culminating in a detailed written report and management strategy, justifying the extended time commitment.
Common Pitfalls
- Billing A835 when the direct patient contact time is less than the required 75 minutes, leading to claim rejection or adjustment to a lesser assessment fee.
- Failing to exclude time spent on separately billable procedures (e.g., performing the nuclear medicine study itself) from the 75-minute consultation duration, violating the 'exclusive of time spent rendering any other separately billable intervention' rule.
- Not obtaining and retaining a written request from the referring physician, nurse practitioner, or dental surgeon, which is a mandatory requirement for this consultation code unless common medical records are maintained.
Billing Tips
- Ensure the patient's medical record clearly documents the start and end times of the direct patient contact to substantiate the 75-minute minimum requirement for A835.
- Verify that a comprehensive written report detailing findings, opinions, and recommendations is provided to the referring provider, as this is a critical component of the A835 service.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Nuclear 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.
The consultant must provide a written report (findings, opinions, and recommendations) to the referring provider. 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.
Minimum of 75 minutes in direct contact with the patient, exclusive of time spent rendering any other separately billable intervention to the patient.
The start and stop times must be recorded in the patient’s permanent medical record.
Must satisfy all the elements of a consultation as defined in the General Preamble ().
The calculation of the 75-minute minimum time excludes non-patient-facing time such as time spent reviewing charts, imaging, or documentation.
If the requirements for a consultation are not met (e.g., no written request), the fee will be adjusted to a lesser assessment fee.
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