Major Consultations

These visit codes are to be claimed when a normal consultation does not recognize the time, effort and complexity involved in the case. The categories and description of Major Consultations are as follows:

Major Medical Consultation: This service may only be claimed by specialists in Internal Medicine and Paediatrics and consists of a general assessment of the patient and findings of disorders in three major systems which result in three separate diagnoses requiring investigation and treatment by the consultant.

 The minimum time period for major medical consultations (to be claimed as such) is 50 minutes. The start and finish times or duration of the service must be part of the patient record for that service. 

A Major Medical Consultation may not be claimed:

(a) when associated with a diagnostic or therapeutic procedure performed by the same physician (e.g. GI endoscopy, cardiac angiography, etc.), except for office ECGs, 

(b) when performed as a pre-operative consult rendered within 48 hours of the surgical procedure, and 

(c) for pre-arranged patient admission to chronic care facilities

Trauma Consultation: This service may be claimed by specialists in General Surgery, Neurosurgery and Orthopaedic Surgery and consists of evaluation and management of a patient with multiple major systems trauma which requires consultation to other surgical specialties and coordination of the patient’s care by the attending surgical specialist.

Major Surgical Consultation: This code is to be claimed for services rendered by a surgeon to a patient who is severely ill and whose condition requires a minimum of 50 continuous minutes of attendance for assessment and stabilization. 

The start and finish times or duration of the service must be part of the patient record for that service. 

Back Consultation: This is payable only to Orthopaedic Surgeons for consultative services provided to a patient with a suspected spinal disorder.

Special Ophthalmology Consultation: This is payable only to Ophthalmology Specialists. It is applicable to claims for consultative services requested by a Neurologist, Paediatric Neurologist, Neurosurgeon or another Ophthalmologist, where decisions regarding medical or surgical treatment are complicated or require extra consideration, judgment and implementation of specialized knowledge and experience. It also applies to consultative services (and the use of low vision aids) provided to “low vision” patients registered with the CNIB and requiring low vision aids. 

The minimum time period for special ophthalmology consultations (to be claimed as such) is 40 minutes. The start and finish times or duration of the service must be part of the patient record for that service. 

 Major Neurological Consultation: This service rendered by a Neurologist shall consist of a detailed assessment of a patient with a complex neurological problem.

The minimum time period for major neurological consultations (to be claimed as such) is 50 minutes. The start and finish times or duration of the service must be part of the patient record for that service.