A895 – Consultation in association with special visit to a hospital in-patient, long-term care in-patient or emergency department patient
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Consultation in association with special visit to a hospital in-patient, long-term care in-patient or emergency department patient
When to Use
- Bill A895 when a psychiatrist is requested for a psychiatric consultation of a hospitalized patient who is experiencing a new onset of severe psychosis, requiring a formal assessment and report to the admitting physician.
- Use A895 for a psychiatrist's consultation with a long-term care resident exhibiting acute behavioral changes suggestive of a new psychiatric condition, where a detailed assessment and written recommendations are required by the attending physician.
- A895 is appropriate when a psychiatrist is consulted for a patient in the emergency department presenting with suicidal ideation, necessitating a comprehensive psychiatric evaluation and a formal report to the ED physician.
Common Pitfalls
- Billing A895 for routine follow-up psychiatric care of an existing condition in a hospital inpatient, as this code is for initial consultations triggered by a special visit request.
- Failure to obtain and retain a written request from the referring physician, nurse practitioner, or dental surgeon for the consultation, which is a mandatory requirement for A895.
- Not documenting the required 60 minutes of direct patient contact for A895, or incorrectly including time spent on other billable services or administrative tasks in this minimum time.
Billing Tips
- Ensure the written report to the referring provider includes findings, opinions, and recommendations, fulfilling the core requirements of a consultation as outlined for A195 and A895.
- When the consultation extends beyond the initial 60 minutes, accurately record the start and stop times for the additional direct patient contact to support billing of K630 extensions.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Psychiatry
Consultation
Written request from referring physician, nurse practitioner, or dental surgeon (for hospital-based dental procedures) must be kept in medical record (or common medical record in hospital/LTC/multi-specialty clinic). The request must identify the consultant, referring provider, and patient, and specify service(s) required.
Must include all elements of a consultation (A195), including a written report (findings, opinions, recommendations) to the referring provider.
Start and stop times of the service must be recorded in the patient's permanent medical record.
The physician must spend a minimum of 60 minutes in direct contact with the patient (exclusive of other separately billable interventions) to qualify for the base fee before extensions (K630) apply.
Calculation of time excludes time devoted to other separately billable services and non-patient-facing time (e.g., chart review, documentation).
Special visit premiums are only eligible for non-elective services (except for home visits) and are subject to specific travel and 'person seen' rules in the General Preamble.
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