1What Is the A026 OHIP Code?
What is A026?
A026 is an OHIP billing code for repeat consultations in dermatology. It applies when a dermatologist sees a patient again for the same condition after prior care by another physician. This often occurs in scenarios such as chronic eruptions managed initially by a family physician, but referred back once first-line treatments fail or the condition changes.
Repeat consultations are significant in managing chronic skin conditions, allowing dermatologists to reassess and modify treatment plans as necessary. It is crucial to receive a new written referral from the referring healthcare provider to qualify for this billing code.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A021 | Advanced Dermatology Consultation | No specific frequency limits | Comprehensive initial consultation for complex dermatological issues. |
| A025 | Consultation | Subject to frequency limits | Initial consultation for dermatological issues. |
| A027 | Consultation with Special Visit to Hospital or Emergency | Subject to frequency limits | Consultation associated with special visits, inpatient or emergency setting. |
| C025 | Consultation | Subject to frequency limits | Consultation service when patient is seen in a hospital setting. |
3Eligibility Requirements
Eligibility Requirements
To bill for A026, the following criteria must be met:
- A new written referral from a physician, nurse practitioner, or dental surgeon is necessary. This serves as proof of the request for a repeat consultation.
- The written request must be retained in the consulting dermatologist's medical record unless the consultation occurs in a hospital, long-term care institution, or a multi-specialty clinic with common records.
- A026 can be billed for video consultations under 'VIDEO ONLY' services; telephone consultations are not eligible.
Failure to fulfill these requirements may result in billing adjustments to a general or specific assessment fee.
4What Your Clinical Note Must Show
To successfully bill A026, documentation must include the following elements:
- A written and signed referral from a referring physician, nurse practitioner, or dental surgeon.
- The consultation note documenting the patient history, examination, and treatment plan.
- Retention of the written referral in the dermatology practice medical records unless in a shared record environment.
5Weak vs. Strong Note Examples
The strong note includes specific details about the consulting scenario, treatment decisions, and documentation adherence, ensuring clarity and code justification. The weak note lacks specificity and omits documentation compliance.
Patient seen for repeat consultation regarding eczema, referred by family doctor. Adjusted treatment.
Patient presents for repeat consultation for chronic plaque psoriasis, initially managed by Dr. Smith, family practitioner.
New referral received due to flare-up post-treatment with topical corticosteroids.
After assessment and patient history review, treatment plan adjusted to include systemic therapy. Referral retained in records per protocol.
