A845 – Limited consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
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, it has the same requirements as a full consultation.
When to Use
- When a referring physician requests a focused opinion on a specific aspect of a patient's medical oncology condition, and the assessment requires less time and depth than a full consultation (e.g., a second opinion on a specific treatment plan).
- When a patient requires a brief assessment for a new, clearly defined medical oncology issue that does not necessitate a comprehensive review of all past medical history, differentiating it from a full consultation (A007).
- When a patient is referred for a follow-up assessment of a previously diagnosed medical oncology condition, but the specific issue being addressed is limited in scope and requires less time than a repeat full consultation (A137).
Common Pitfalls
- Billing A845 when the documentation does not include a written request from a referring physician, nurse practitioner, or dental surgeon, or if the request lacks essential details like patient and physician identifiers.
- Submitting A845 without a corresponding written report detailing findings, opinions, and recommendations sent back to the referring provider, which can lead to the fee being reduced to a lesser assessment fee.
- Claiming A845 more than once within a 12-month period for the same diagnosis, or more than once in two consecutive 12-month periods for the same diagnosis, violating usage limits.
Billing Tips
- Ensure the written request clearly specifies the limited nature of the consultation required, distinguishing it from a full consultation (A007) or repeat consultation (A137).
- Verify that the report sent to the referring provider includes specific findings, opinions, and recommendations relevant to the limited scope of the A845 consultation.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
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 consultation includes the services necessary to enable the consultant to prepare a written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner or dental surgeon.
Except where otherwise specified, the consultant is required to perform a general, specific or medical specific assessment, including a review of all relevant data.
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