A011 OHIP Billing Code: Efficient Video Consultations for Focused Practices

The A011 billing code is designated for repeat consultations by a General Practitioner (GP) in a focused practice area, conducted via video. These consultations require the physician to complete a full, relevant history and a detailed examination related to the presenting complaint, aiming to formulate a diagnosis or assess the function. Typical focused practice areas include sports medicine, addiction medicine, and care of the elderly, where the patient is reviewed again for the same issue after an initial consultation. These repeat consultations are driven by a new written request from the referring physician, ensuring continuous and integrated patient care.

Due to its nature, this code is often utilized when a GP needs to reassess an ongoing issue initially evaluated in a face-to-face or video consultation. It is essential to clearly document the necessity of the consultation and maintain proper communication with the referring physician, nurse practitioner, or dental surgeon. A common pitfall in utilizing the A011 code tends to be overlooking the requirement of a fresh written request, which can lead to billing errors or adjustments.

To bill for the A011 code, specific eligibility requirements must be met: a GP must have focused practice designation granted by the MOH-OMA GP Focused Practice Review Committee or be eligible for the psychotherapy premium. Additionally, a repeat consultation via video must follow an initial consultation for the same issue, with a new written request signed by the referring healthcare professional (physician, nurse practitioner, or dental surgeon).

A copy of this written request must be kept in the consulting physician’s medical record, except in cases where common medical records exist, such as in hospitals, long-term care institutions, or multi-specialty clinics. If these requirements are not satisfied, the consultation fee may be reduced to a basic assessment fee.