1What Is the A005 OHIP Code?
A family medicine consultation billed under A005 involves a comprehensive assessment conducted following a written request from a referring physician, nurse practitioner, or dental surgeon. This code is typically used when consulting about complex cases such as polypharmacy issues or unexplained functional decline.
Consultations under A005 require the consultant physician to provide both an in-depth evaluation and a detailed report back to the referring party. In family practice, these consultations ensure the physician's opinion is shared efficiently, often to determine or adjust patient management strategies.
A005 is commonly missed due to lapses in securing the required written request or failure to document requisite details. Ensuring that all criteria are met before billing is crucial to avoid denials.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A914 | GP focused practice comprehensive consultation by Video | Variable | A thorough consultation performed via video, specifically for focused practice. |
| A006 | Repeat consultation | As needed, within limits | A follow-up consultation on the same issue, requiring less involvement than an initial consultation. |
| A010 | GP focused practice consultation by Video | Variable | Standard consultation conducted via video conferencing. |
| A011 | GP focused practice repeat consultation by Video | As needed, within limits | Follow-up consultation via video conferencing after an initial consultation. |
3Eligibility Requirements
To be eligible for billing A005, several requirements must be met:
- The consultation must follow a written request for opinion from a referring physician, nurse practitioner, or dental surgeon who is familiar with the patient and recognizes the complexity or seriousness of the case.
- A copy of the written request must be retained in the consultant physician's medical records, except in hospitals or multi-specialty clinics with common records.
- The request should identify both the consultant and the referring healthcare provider by name and billing number, and it should detail the patient's name and health number.
- The consultation request must clearly state the relevant information and services required.
Consultations are limited to one service per two consecutive 12-month periods unless the consultation occurs in a hospital or ER setting more than 12 months but less than 24 months after the first consultation, or is for an unrelated diagnosis.
4What Your Clinical Note Must Show
A written request must be obtained and maintained in records.
- Include referring physician, nurse practitioner, or dental surgeon details.
- Clearly state the consulting needs and patient details.
Maintain a thorough record of each consultation.
- Record start and end times of the consultation.
- Attach the written report prepared for the referring party.
5Weak vs. Strong Note Examples
The strong note is detailed, showing a structured assessment and clear communication back to the referrer, whereas the weak note lacks specific details and documentation of actions taken.
Seen patient as requested by Dr. Smith. Discussion on medication.
Patient referred by Dr. Smith for polypharmacy assessment.
Comprehensive review of patient history and current medications performed.
Recommendations included adjusting dosages to mitigate adverse effects.
- Written report sent to Dr. Smith on findings and recommendations.
- Consultation duration recorded from 10:00 AM to 10:30 AM.
