1What Is the A064 OHIP Code?
A064 is an OHIP billing code used for partial assessments in orthopedic contexts. Orthopedic surgeons may use this code for concise follow-up evaluations that address one or two specific aspects of a patient's condition. It is typically employed for routine follow-ups, such as checking a cast or reviewing a repeat x-ray.
Due to its focused nature, this code facilitates efficient management of follow-up care and quick reassessment when a comprehensive evaluation is unnecessary. This might be overlooked when a more comprehensive review is not required but mistakenly billed with other codes.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A063 | Specific assessment | As per specialty guidelines | Detailed orthopedic evaluation focusing on specific issues. |
| C063 | Specific assessment | As per specialty guidelines | Inpatient orthopedic assessment. |
| C064 | Specific re-assessment | As per specialty guidelines | Follow-up on specific inpatient orthopedic issues. |
| A935 | Special surgical consultation | Once per patient per referral case | Comprehensive evaluation and planning for surgical candidates. |
3Eligibility Requirements
To qualify for billing under A064, the service must consist of a limited assessment that includes the history of the presenting complaint, necessary physical examination, and patient advisement. Physicians must document the service's start and end times in the patient's medical record. It is crucial to note that A064 can be rendered and billed virtually as A064A, allowing for video or telephone consultations. When this code is applied to hospital inpatients, C064 is the corresponding billing option.
This code does not include major pre-operative visits where the decision to perform surgery is made, and it cannot be billed for surgical admissions unless it's also the major pre-operative visit.
4What Your Clinical Note Must Show
To ensure accurate billing, the following documentation is required:
- Record the timing of service (start and end).
- Document the history of the presenting complaint.
- Include details of the physical examination performed.
- Provide patient advisement notes.
- Ensure completeness and clarity of notes for virtual consultations.
5Weak vs. Strong Note Examples
The strong note effectively communicates the nature of the assessment, integrates objective findings, and provides a clear advisement path, while documenting time spent, making it thorough and informative. The weak note lacks detail and fails to demonstrate the scope of the assessment.
Patient seen for follow-up. Cast checked.
Conducted a follow-up partial assessment on patient's right forearm cast. Reviewed x-ray, confirming stability of fracture. Advised patient on maintaining cast care. Service conducted from 10:00 to 10:15.
- Clearly states the specific aspect assessed.
- Confirms findings with objective data (x-ray).
- Provides advisement and notes service duration.
