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Bulletin Number
        4318
Date
        September 23, 1998
Direct inquiries to

         Ministry of Health
         Processing Office


(address below)
Distribution  
Physicians, Hospitals, Clinics, and Laboratories
Subject     Consultations

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 consultation fee.

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