On April 1, 1998 the Schedule of Benefits was amended to the effect that a consultation
may only be claimed to the Plan when the request for the opinion from another physician
(GP or specialist) is made in writing. The written request will not only confirm that a
request for consultation was made but, more importantly, it provides valuable information
required for the assessment and treatment of the patient. Further, it should prevent
unnecessary duplication of tests already ordered by the referring physician.
In hospitals (including emergency departments and outpatient departments),
nursing homes, long-term care facilities and multi-speciality clinics, the referral for
consultation will not need to be accompanied by a separate referral letter, but must be
recorded in the patient’s medical record. These are not exemptions from having to
make the referral for consultation in writing, but are exceptions from having to record
the referral for consultation in a separate document.
Urgent Cases:In urgent situations outside of
hospital, the referral letter may accompany the patient or be sent subsequently.
Inquiries to the Ministry have identified certain areas
that require clarification:
Ongoing/Follow Up Care:In some cases after a
consultant physician has seen a patient at the request of another physician, there
continues to be ongoing or follow up care by the consultant. The subsequent visits for
that ongoing or follow up care must be claimed using the appropriate assessment fee, not
the fees for consultation or repeat consultation . For example, the ophthalmologist who
sees a diabetic patient in consultation and determines that the patient requires annual
review, would claim a consultation for the first contact with the patient and the
appropriate assessment fee for any subsequent follow up visit. Consultation fees may not
be charged for follow-up visits whether more than 12 months have elapsed or not.
Patient Initiated Visits:When a physician
provides a service at the request of a patient and not at the request of another
physician, the service must be claimed using the appropriate assessment fee and not a