Concept: Physician Consultation Visits

What is a Consult?

Consultations are a subset of Ambulatory Visits - Physician. Consultations occur when one physician refers a patient to another physician (usually a specialist or surgeon) because of the complexity, obscurity or seriousness of the condition, or when the patient requests a second opinion. A consultation can be with either a general practitioner/family practitioner (GP/FP) or a specialist, after which the patient usually returns to their own GP/FP for ongoing management.

The consultation rate is a measure of "initial" access to specialist care. People in urban areas often have higher rates of visit to specialists, since they may continue to see the specialist rather than being referred back to their GP/FP. That is why the consultation rate, rather than the total specialist visit rate, is used as an indicator for access to specialist care. (Fransoo et al., 2013).

Definition

The physician tariff codes in the Medical Services Data are used to select consultations. Due to the changing nature of tariff codes, a variety of codes have been used in different studies.

1. Fransoo et al. (2005)

In Fransoo et al. (2005), the definition of a consultation is a physician claim with tariff prefix = 7 and one of the following tariff codes:


• 8516 - pre-anaesthetic consultation within 72 hours of anaesthetic service;
  
• 8550 - consultation;
  
• 8553 - psychiatry consultation - adult;
  
• 8554 - psychiatry consultation - child;
  
• 8556 - ophthalmology consultation, including refraction and other necessary tests (doctor or optometrist);
  
• 8557 - otorhinolaryngology (ENT) consultation;
  
• 8595 - consultation - unassigned patient; and
  
• 8596 - consultation - unassigned patient - child (under 16 years).

2. Frohlich et al. (2006)

In Frohlich et al. (2006) , the following tariff codes were used in the definition.


• 8550 - consultation;
  
• 8556 - ophthalmology consultation, including refraction and other necessary tests (doctor or optometrist);
  
• 8557 - otorhinolaryngology (ENT) consultation;
  
• 8595 - consultation - unassigned patient;
  
• 8555 - parent interview and counselling related to a previous developmental assessment;
  
• 8516 - pre-anaesthetic consultation within 72 hours of anaesthetic service; and
  
• 8596 - consultation - unassigned patient - child (under 16 years).

The following tariff codes were investigated as consultations, but none of these codes were used in the definition:


• 4800 - c-section;
  
• 8440 - orthopedic spinal consultation;
  
• 4806 - amniocentesis, initial or subsequent;
  
• 8553 - psychiatry consultation - adult; and
  
• 8554 - psychiatry consultation - child;

3. Fransoo et al. (2009), Martens et al. (2010), Chartier et al. (2012), and Fransoo et al. (2013)

In Fransoo et al. (2009), Martens et al. (2010), Chartier et al. (2012) and Fransoo et al. (2013), the following tariff codes were used to identify ambulatory consultations:


• 8440 - orthopaedic spinal consultation;
  
• 8449 - extended ophthalmology consultation for the assessment and/or treatment of uveitis;
  
• 8550 - consultation;
  
• 8552 - developmental assessment and report per 15 minute period or portion thereof;
  
• 8553 - psychiatry consultation - adult;
  
• 8554 - psychiatry consultation - child;
  
• 8556 - ophthalmology consultation, including refraction and other necessary tests (doctor or optometrist); and
  
• 8557 - otorhinolaryngology (ENT) consultation.

Three tariff codes (8516, 8595, and 8596) were investigated and removed from the existing definition. These tariff codes were removed because the project did not want to include consults that took place in an ER or some clinic pre-surgery; only ambulatory / office visits. After discussion with Alan Katz, these tariffs were removed as they did not appear to be regular, in-office consults.

4. Fransoo et al. (2019)

In Fransoo et al. (2019), the following tariff codes were used to identify ambulatory consultations:


• 8440 - orthopaedic spinal consultation
  
• 8449 - extended ophthalmology consultation for the assessment and/or treatment of uveitis
  
• 8550 - consultation
  
• 8552 - developmental assessment and report per 15 minute period or portion thereof
  
• 8553 - psychiatry consultation—adult
  
• 8554 - psychiatry consultation—child
  
• 8556 - ophthalmology consultation, including refraction and other necessary tests (family physician or optometrist)
  
• 8557 - otorhinolaryngology (ENT) consultation
  
• 8622 - consultation, geriatric patient
  
• 8620 - extended consultation (incl. requests by Geriatric Program Assessment Team, GPAT), minimum of 45 minutes of patient/physician contact time.
  
• 8107 - consultation initiated by Allied Health Professionals to RN (EP)
  
• 8108 - consultation initiated by RN (EP) to Allied Health Professionals
  
• 8139 - consultation initiated by Family Physician to RN (EP)
  
• 8140 - consultation RN (EP) to RN (EP).

Issues

• Tariff codes may change over time. When using these codes researchers should confirm that additional codes have not been added (after May 2006) that include consultations.
  
  
• GP/FP are typically identified using the Provider Registry (Physician Master File) data for the identified year. This may not be possible before 1990/91 in which case the MD Bloc of specialty may be used (MDBLOC=:'11').
  
  
• The use of just a referring physician to identify a consult has been tested. In rural areas there are a significant number of referrals done by GP/FP that are not consultations. When looking at consults the addition of the consult tariffs should be used.