1What Is the A086 OHIP Code?
A086 is an OHIP billing code specifically for repeat consultations in the field of plastic surgery. This service applies when a patient is referred back to a plastic surgeon for the same presenting problem, after seeing another physician in between consultations. Examples include a scar maturing differently than anticipated or a lesion that has changed since the initial assessment.
Repeat consultations are distinct as they require a new written request from a referring physician, nurse practitioner, or dental surgeon. This ensures the specialist revisits the patient's condition with updated insights following intervention or care by another healthcare provider.
A common oversight occurs when billing for repeat consultations without new written referrals. Without meeting this prerequisite, the consultation is downgraded to a general or specific assessment, affecting reimbursement.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | A935 Special surgical consultation | N/A | Indicative of complex cases necessitating a higher level of intervention, often for unique or severe plastic surgery scenarios. |
| C935 | C935 Special surgical consultation | N/A | Applicable for special surgical consultations conducted for inpatients, aligning with complex consultation needs. |
| A085 | A085 Consultation | N/A | The standard initial consultation code for plastic surgery cases, preceding repeat consultations. |
| C085 | C085 Consultation | N/A | Consistent with standard initial consultation needs for inpatient scenarios in plastic surgery. |
3Eligibility Requirements
To bill the A086 code, the following eligibility requirements must be met:
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New Written Request: A new written referral from a referring physician, nurse practitioner, or dental surgeon is mandatory. This must be maintained in the consulting physician's records, unless common medical records are used in a hospital or long-term care institution.
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Same Presenting Problem: The repeat consultation must address the same presenting problem for which the initial consultation was conducted.
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Patient Journey: The patient should have received care from another physician for the same issue in the period between the initial consultation and the repeat consultation.
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Exclusion from Frequency Limits: Repeat consultations are not subject to the standard frequency limits applied to consultations in the OHIP system.
4What Your Clinical Note Must Show
Ensure the following documents are filed in the patient's medical record to support the billing of A086:
- A new written referral request is mandatory and should be preserved unless it's a shared medical record in a hospital setting.
- Verify the consultation addresses the identical issue identified during the initial consultation.
5Weak vs. Strong Note Examples
The strong note succeeds as it captures the critical components of a valid repeat consultation: the referring physician, the condition's progression, and a clear treatment plan. The weak note misses these essential elements, lacking context and specifics.
Patient seen again for scar review. Changes noted. Plan to monitor further.
Patient returned for repeat consultation due to changes in scar presentation since initial consult. Previously assessed on date 2 months prior, referred by Dr. Smith for same issue. Scar showing unexpected hypertrophy. Discussed potential treatment options and patient consented to follow-up.
- Includes date of initial consultation.
- Mentions referring physician and reason for current visit.
- Details changes in patient's condition and next steps.
