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B605
B605 – B605
OHIP Paediatrics Code · Schedule of Benefits
When to Use
- B605 is appropriate when a physician provides a consultation or assessment for a patient referred by another physician, and the consultation itself is the primary service provided, without a subsequent procedure or management plan that would warrant a different diagnostic or consultation code.
- Use B605 when a patient presents for a specific diagnostic assessment, such as a pre-operative assessment for a procedure not performed by the consulting physician, and the assessment is documented and billed independently.
- This code is suitable for situations where a physician performs a focused assessment of a patient's condition that requires specialized knowledge, but the findings do not immediately lead to a specific treatment plan or intervention billable under other codes.
Common Pitfalls
- Billing B605 concurrently with other consultation codes (e.g., A001, A007) for the same patient encounter is a common error and will lead to rejection.
- Submitting B605 for routine follow-up visits or management of chronic conditions that should be billed with appropriate assessment and management codes (e.g., K005, K013) is incorrect.
- Failure to document the specific reason for the consultation and the findings of the assessment in the patient's chart can lead to audit issues if B605 is questioned.
Billing Tips
- Ensure the patient referral is documented, clearly indicating the reason for the consultation, to support the use of B605.
- B605 is intended for a single consultation; if further assessment or management is required, bill subsequent services using appropriate codes.
Provider Fee$0.00
Specialist Fee$0.00
Effective: December 1, 2015
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