1What Is the A027 OHIP Code?
What is the A027 OHIP Billing Code?
A027 is an OHIP billing code primarily used by dermatologists for consultations conducted during special visits to a hospital in-patient, long-term care in-patient, or emergency department patient. This code specifically covers the consultation component when an urgent dermatological opinion is required, often in cases such as blistering eruptions, suspected drug reactions, or necrotising skin infections.
Due to its complex and specialized nature, this consultation typically occurs when an immediate and knowledgeable expertise is necessary, as these conditions may require swift diagnosis and management. It is vital that dermatologists understand the parameters under which this code is applicable, as it requires fulfilling certain eligibility and documentation requirements.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A021 | Advanced Dermatology Consultation | As per Dermatology (02) listings | Higher fee consultation for complex dermatological cases. |
| A025 | Consultation | As per Dermatology (02) listings | Standard consultation fee for dermatological cases. |
| A026 | Repeat consultation | As per Dermatology (02) listings | Fee for repeat consultations, less than initial consultations. |
| C025 | Consultation | As per Dermatology (02) listings | Standard consultation with a specific listing fee. |
3Eligibility Requirements
Eligibility for A027
To bill A027, several criteria must be met:
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Consultation Request: The consultation must be initiated by a written request from a referring physician, nurse practitioner, or dental surgeon. This request should clearly identify the consulting dermatologist and set out relevant information and services required.
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Documentation: A copy of the written request must be retained in the dermatologist's medical records, unless within a shared medical record system in hospitals or long-term care institutions.
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Frequency Limits: Service is limited to one consultation per two consecutive 12-month periods per patient for the same diagnosis. Exceptions allow for a second consultation under specific circumstances, such as in a hospital setting more than 12 but less than 24 months after the first consultation. For unrelated diagnoses, the limit is one service every 12 months.
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Consultation Components: The service includes the consultation and preparation of a written report to the referring professional. Failure to meet these criteria may result in reduced payment.
4What Your Clinical Note Must Show
Ensure the following documentation is included for compliance with OHIP requirements:
- A written consultation request from a referring physician, nurse practitioner, or dental surgeon, including the consultant's name and specialty.
- Patient's identifying information and relevant health number.
- A detailed report with the consultant's findings, opinions, and recommendations sent to the referrer.
- Time recording: Start and end time of the consultation must be noted in the patient's permanent medical record.
5Weak vs. Strong Note Examples
The strong note is successful because it provides a complete clinical picture with detailed observations, differential diagnosis, and a specific management plan, all communicated comprehensively to the referring physician. The weak note lacks specificity and fails to convey the complexity of the case.
Consulted on suspected drug reaction. Report sent.
Patient presented with a suspected drug-induced blistering eruption.
A comprehensive assessment was conducted, involving a detailed review of the patient's medication history and current symptoms.
- Findings: Erythematous lesions with blistering on the trunk.
- Impression: Likely drug reaction, differential includes pemphigus due to lesion characteristics.
- Plan: Discontinue suspect medication, consider biopsy if no improvement.
- Report sent to Dr. Smith (referring physician) detailing assessment and plan.
