1What Is the A076 OHIP Code?
A repeat consultation (A076) is a service billed when a geriatrician sees a patient for the same issue following care by another physician. This service is crucial in geriatrics for managing progressive issues like cognitive decline, where symptom changes or functional drops necessitate re-evaluation.
The repeat consultation requires a new written request from the referring healthcare provider. This ensures continuity of care while maintaining transparency in patient management. Despite being a common necessity in geriatrics, this code is often missed due to lack of documentation or misunderstanding of referral requirements.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A070 | Consultation with special visit to hospital in-patient | as necessary with special visit | Used for consultations involving special visits to hospital or long-term care settings. |
| A075 | Consultation | limited by GP consultation frequency rules | General geriatric consultation, first in series or no applicable repeat scenario. |
| A375 | Limited consultation | for straightforward issues | Shorter consultation for limited assessments. |
| A770 | Extended comprehensive geriatric consultation | as necessary for complex cases | For comprehensive assessments covering multiple, complex geriatric conditions. |
3Eligibility Requirements
To bill A076, ensure compliance with OHIP eligibility criteria:
- New Written Request: A repeat consultation must be accompanied by a fresh written request from a referring physician, nurse practitioner, or dental surgeon. This request must be documented in the patient’s medical records. Exceptions apply for institutionalized settings where common records are maintained.
- Interval Care: The repeat consultation should address the same issue initially consulted upon, with interval care by another physician.
- Virtual Services: A076 can be billed virtually as A076A for video consultations only. Telephone consultations are excluded.
Failure to adhere to these requirements can lead to downgraded payments.
4What Your Clinical Note Must Show
Essential records for billing A076:
- A new written request from a referring physician, nurse practitioner or dental surgeon retained in medical records.
- Ensure the consultation addresses the same presenting problem with care provided by another physician in between consultations.
- Include documentation of virtual consultations if billed as A076A, specifying video usage.
5Weak vs. Strong Note Examples
The strong note includes specific details about the referral source, reason for repeat consultation, and continuity since the initial consultation, whereas the weak note lacks any reference to the necessary referral or interval care.
The patient was seen today for a follow-up.
Follow-up appointment after referral by Dr. Smith due to patient’s progressive cognitive decline.
Patient's behavior changed after initial consultation. New referral by Dr. Smith documented.
- Original consultation addressed cognitive decline.
- Care by another physician documented between consultations.
- New issues with cognitive function and behavior leading to this repeat consultation.
