Major Medical Consultation

Prenatal Consultation: This service is payable to a Paediatrician or Neonatologist for a requested consultation on a high-risk fetus between 16 and 32 weeks gestation upon referral from an Obstetrician or Perinatologist. Only one prenatal consult is payable per pregnancy per physician. This code is to be billed using the mother’s MCP number. Detention is not payable with this service. 

 Intraoperative Consultation: This service may be claimed when a consultant is called to the operating room by the operating surgeon to give advice when a case is complicated and/or additional judgement, based on specialized knowledge and experience, is required. 

The consultant should review the pertinent history, intraoperative findings, x-ray and laboratory data as necessary, and submit their opinion and recommendations in writing to the referring surgeon.

Consultations required of Psychiatrists under the Mental Health Act or by court order are payable by MCP. The patient record must show that the attending Psychiatrist performed an examination commensurate with the needs of the patient.

Nuclear Medicine Therapeutic Consultation: Is only payable when no isotope treatment is carried out. It is intended to recognize evaluation of the patient for whom treatment is found to be not indicated. To claim this fee the Nuclear Medicine Specialist is required to obtain from the patient a full history of the presenting problem, to perform a full physical examination (General Assessment) of the patient and review laboratory reports with respect to the requested treatment with non-sealed radioisotopes. When the decision is made to not proceed with the requested treatment or with any alternative treatment, a consultation report shall be sent to the physician who requested the isotope treatment, stating all of the above findings and giving the basis for the decision to not proceed. This service may be claimed as often as it is medically necessary. 

 Diagnostic Radiology Consultation: A diagnostic radiology consultation applies when insured imaging studies made elsewhere are referred to a Radiologist for his/her written opinion. It is not payable for the reading of insured imaging studies sent for reporting. As well, a consultation does not apply when the insured imaging studies referred to above are used for comparison purposes with images made in the consultant’s facilities. Claims for consultation must be submitted IC and accompanied by a copy of the referring letter and the Radiologist’s report. This service may be claimed as often as it is medically necessary.

Interventional Radiology Consultation: An Interventional Radiology Consultation applies when an Interventional Radiologist is requested by another Specialist to assess a patient whose condition may require a procedure listed in the Interventional Radiology Section of this Payment Schedule. The Interventional Radiologist must give their opinion in writing to the referring Specialist. The consultation is payable whether or not the Interventional Radiologist performs a procedure.