1What Is the A095 OHIP Code?
A095 is an OHIP billing code used for consultations in the field of cardiac surgery. This code is applied when a cardiac surgeon assesses a new patient who has been referred, typically by a cardiologist, for potential coronary bypass or valve repair/replacement procedures. These consultations are crucial in determining the operability and optimal timing for surgery.
In the context of cardiac surgery, these consultations involve a comprehensive evaluation of the patient's condition. They often involve reviewing the patient's history, current symptoms, and previous diagnostic tests to form a surgical opinion regarding potential procedures.
This billing code can sometimes be overlooked if proper documentation or the specific referral request isn't maintained. Ensuring all paperwork, including the written referral and detailed consultation report, is vital for correct billing under this code.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | As needed | Comprehensive surgical consultation requiring significant expertise due to complexity. |
| C935 | Special surgical consultation | As needed | Used when the consultation is performed on an in-patient. |
| A096 | Repeat consultation | Varies by case | Used for follow-up consultations requiring further surgical opinion. |
| C095 | Consultation | Same as A095 but for in-hospital settings | In-patient cardiac consultation equivalent to A095. |
3Eligibility Requirements
Eligibility Requirements for A095
To be eligible for billing under A095:
- A formal, written request for consultation must be present from a referring physician, nurse practitioner, or dental surgeon. This request should reflect the need for the cardiac surgeon's opinion due to the patient's complex or serious condition.
- The consultant must provide a written report to the referring physician, which includes the findings, opinions, and recommendations derived from the consultation.
- A copy of the consultation request must be kept in the consulting physician's medical records, except in institutions with shared medical records.
- The time when the consultation started and ended must be recorded in the patient's permanent medical record.
Consultations under A095 are limited to one service per two consecutive 12-month periods unless the specific conditions for a second consultation are met. Exceeding these limits results in reimbursement at the assessment rate.
4What Your Clinical Note Must Show
Detailed documentation must accompany the use of A095.
- Maintain a copy of the written consultation request in the medical record.
- Document the start and end times of the consultation in the patient's record.
- Prepare a written report for the referring provider detailing findings and recommendations.
5Weak vs. Strong Note Examples
The strong note clearly identifies the referring physician and provides a comprehensive overview of the patient's situation, while the weak note lacks sufficient detail and specificity.
Consultation performed. Patient referred for further evaluation.
Consultation conducted following referral by Dr. Smith, cardiologist. Patient displays symptoms consistent with coronary artery disease, warranting coronary bypass. Diagnostic tests and patient history evaluated. Recommendations and findings will be communicated in a detailed report sent to Dr. Smith.
- Explicit mention of the referring physician.
- Detailed assessment of patient's condition.
- Clear identification of plan and recommendation.
