A935 – Special Surgical Consultation
OHIP General Listings Code — General Surgery (03), Neurosurgery (04), Obstetrics and Gynaecology (20), Ophthalmology (23), Orthopaedic Surgery (06), Otolaryngology (24), Plastic Surgery (08), Urology (35), Vascular Surgery (17) · Schedule of Benefits
A special surgical consultation is rendered when a surgeon provides all the appropriate elements of a regular consultation and is required to devote at least fifty minutes exclusively to the consultation with the patient. The calculation of the 50 minute minimum excludes time devoted to any other service or procedure for which an amount is payable in addition to the consultation. A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon who, in light of his/her professional knowledge of the patient, requests the opinion of a physician (the "consultant physician”) competent to give advice in this field because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient or patient's representative. The service includes all services necessary to enable the consultant to prepare a written report (including findings, opinions, and recommendations) to the referring practitioner. See and for full details.
When to Use
- Bill A935 when a surgeon spends a minimum of 50 minutes exclusively assessing a patient referred by another physician, nurse practitioner, or dental surgeon for a complex or obscure condition.
- Use A935 for a second opinion consultation requested by the patient or their representative, provided the surgeon dedicates at least 50 minutes solely to the consultation and report preparation.
- A935 is appropriate when a specialist surgeon provides a comprehensive assessment and written report, requiring at least 50 minutes of dedicated time, following a formal referral.
Common Pitfalls
- Billing A935 when the consultation time is less than 50 minutes; use a standard consultation code (e.g., A007) or assessment code instead.
- Including time spent performing procedures or other billable services within the 50-minute minimum for A935, as this time must be excluded.
- Failing to obtain and retain a written request for consultation from the referring provider, unless the consultation occurs in a setting with common medical records.
Billing Tips
- Document the exact start and end times of the consultation in the patient's chart to substantiate the 50-minute minimum duration required for A935.
- Ensure the referral documentation clearly identifies the patient, referring provider (with billing number), and the specific reason for the consultation.
Effective: June 1, 2025
Consultations and Visits
General Surgery (03), Neurosurgery (04), Obstetrics and Gynaecology (20), Ophthalmology (23), Orthopaedic Surgery (06), Otolaryngology (24), Plastic Surgery (08), Urology (35), Vascular Surgery (17)
Consultation
Consultations
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, 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 physician must record on the patient's permanent medical record or chart the time when the insured service started and ended to document the minimum 50 minute duration.
In the preoperative preparation of a patient undergoing the following low risk elective surgical procedures under local anaesthesia and/or I.V. sedation, a preoperative consultation by any physician is only eligible for payment where the medical record demonstrates the consultation is medically necessary. a.cataract surgery; b.colonoscopy; c.cystoscopy; d.carpal tunnel surgery; or e.arthroscopic surgery.
Commentary: Such medically necessary consultations would be very uncommon.
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