1What Is the A585 OHIP Code?
A585 refers to the diagnostic consultation service provided by a laboratory physician when tissue, slides, specimens, or laboratory results are reviewed after being referred from another licensed laboratory. This task typically requires a written opinion without any direct patient encounter. It is a crucial service when providing a second reading for difficult surgical pathology or haematopathology cases to ensure accurate diagnosis.
This consultation requires a high degree of expertise and is often called upon when the complexity, seriousness, or obscurity of a lab result demands a third-party professional opinion. As no direct interaction with the patient occurs, the focus is entirely on the interpretation of the provided scientific material.
Diagnostic consultations can be missed if the referring process does not meet specific documentation requirements, or if there is an overlap with materials prepared in the same laboratory, contrary to the rules specified.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A285 | Consultation | Not specified | Consultation in the Laboratory Medicine listings. |
| A286 | Limited consultation | Not specified | Limited consultation service within Laboratory Medicine listings. |
| A580 | Comprehensive internal medicine consultation | Not specified | Comprehensive consultation in internal medicine. |
| A586 | Repeat consultation | Not specified | Repeat consultation service within Laboratory Medicine listings. |
3Eligibility Requirements
Eligibility Requirements for A585
A585 is not a face-to-face consultation. The Schedule defines a diagnostic laboratory medicine consultation as the service rendered when tissue, slides, specimens and/or laboratory results prepared in one licensed laboratory are referred to a laboratory medicine physician not in the same licensed laboratory for a written opinion. The specific elements are the same as for the L800 series of codes.
- Different licensed laboratory: the material must have been prepared in a licensed laboratory other than the consultant's. Material prepared in the consultant's own laboratory does not qualify.
- Written opinion: the service is the written interpretation of the referred material. There is no patient encounter, so no history, examination or direct patient contact is required.
- Comparison-use exclusion: A585 is not eligible for payment when tissues, slides, specimens and/or laboratory results from a different licensed laboratory are used for comparison purposes with material done in the consultant's own licensed laboratory.
- Other services billed with it: with the exception of the services set out under "Special Procedures and Interpretation - Histology or Cytology", any other service rendered by the physician in association with a diagnostic laboratory medicine consultation is not eligible for payment.
What does not apply. The General Preamble consultation requirements and frequency limits (GP16 to GP18) are not part of this service. The Schedule does not require a written request from a referring physician, nurse practitioner or dental surgeon for A585, and it sets no per-patient or per-12-month limit. The patient-facing consultations in the same Laboratory Medicine listing (A285, A286, A586) are the codes those General Preamble rules govern.
4What Your Clinical Note Must Show
The Schedule states no separate documentation requirement for this service beyond the record of the service itself. What has to be demonstrable is the two facts payment turns on:
- That the material was prepared in a licensed laboratory other than the consultant's.
- The written opinion itself - the interpretation is the service.
- That the outside material was the subject of the opinion rather than a comparison against work done in the consultant's own laboratory.
5Weak vs. Strong Note Examples
What makes a record adequate for this code is not a referral letter but provenance and product: which licensed laboratory prepared the material, that it was not your own, and the written interpretation itself.
Slides reviewed. Diagnostic opinion given.
Nothing records which laboratory prepared the material, so the one fact payment turns on is absent.
Histological slides on patient J. Doe, prepared and initially interpreted at XYZ Laboratory (a licensed laboratory other than this one), referred here for a written interpretation of the lymphoid infiltrate.
- Provenance: material prepared at XYZ Laboratory; no material from this laboratory was involved.
- The referred material is the subject of the opinion, not a comparison against work done here.
- Written interpretation issued and returned to the referring laboratory, retained in the record.
- No other service was billed on this material apart from the Special Procedures and Interpretation (Histology or Cytology) services, if any.
