All codes
V404
V404 – V404
OHIP Other Code · Schedule of Benefits
When to Use
- Use V404 for a formal consultation requested by a referring physician for a patient with a specific medical problem, provided the patient has not been seen by you for the same condition within the previous 12 months.
- Use this code when providing a comprehensive assessment and written report to the referring physician, distinguishing it from a minor assessment (A007) or a repeat visit (A001).
Common Pitfalls
- Billing V404 for a patient you have already seen for the same condition within the last year, which should instead be billed as a repeat consultation (A404) or a subsequent visit (A001).
- Failing to ensure the referring physician's billing number is included in the claim, as the Ministry requires a valid referral source to validate the consultation fee.
- Submitting V404 when the service provided was actually a minor assessment or a routine follow-up, which triggers audit flags for inappropriate code selection.
Billing Tips
- Ensure your clinical notes clearly document the referral request and the specific medical problem addressed to support the consultation status during a post-payment audit.
Provider Fee$51.00
Effective: April 1, 2023
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