1What Is the A096 OHIP Code?
What is A096?
A096 is an OHIP billing code used for repeat consultations in cardiac surgery. It applies when a cardiac surgeon revisits the same patient for the same issue, following care by another physician in between the consultations. Such consultations are essential for cases where clinical changes suggest a new evaluation of the patient's condition, such as progression in valve disease. Cardiac surgeons often use this code to see patients who were not initially deemed suitable for surgery but whose condition has evolved warranting a reassessment.
Frequent reasons for missing A096 opportunities include failing to secure a new written referral or misidentifying the encounter as a routine assessment rather than a repeat consultation. This error can lead to reduced fees if billed under a lesser assessment code.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | Available as required, unique circumstances | Used for highly complex cases requiring detailed surgical planning. |
| C935 | Special surgical consultation | Available as required, unique circumstances | Used for inpatient settings with particular surgical complexity. |
| A095 | Consultation | Limited to one service per two consecutive 12-month periods | Initial consultation code for cardiac surgery. |
| C095 | Consultation | Limited to one service per two consecutive 12-month periods | Used similarly to A095, applicable in inpatient settings. |
3Eligibility Requirements
Eligibility Requirements
For a consultation to qualify as a repeat consultation under A096, the following criteria must be fulfilled:
- A new written request for the consultation, signed by the referring physician, nurse practitioner, or dental surgeon, must be kept in the consulting physician's medical records, except when consultations occur in hospitals or multi-specialty clinics with shared medical records.
- The repeat consultation must address the same presenting problem, but it requires that another physician has provided care in the time interval between the initial consultation and the repeat consultation.
- Repeat consultations are not subject to the same frequency limitations as initial consultations but can be billed more than once in a 12-month period without restriction. Each instance, however, requires a new request.
- In the context of virtual delivery, A096 can be billed as A096A when conducted via video, but telephone consultations are excluded.
4What Your Clinical Note Must Show
Ensure the following for successful A096 claims:
- Maintain a new written request from the referring provider.
- Document the interim care provided by another healthcare professional.
- Retain comprehensive records: patient notes, referral date, consultation findings.
5Weak vs. Strong Note Examples
The strong note succeeds by detailing the patient's clinical changes and the context of referral, ensuring documentation supports the specialized nature of the repeat consultation unlike the weak note.
Patient seen for follow-up on previous consultation. Discussed symptoms.
Repeat consultation for Mr. Smith due to new symptom development in coronary artery disease, following care by Dr. Jones (referring GP).
Initial consultation rejected surgery due to manageable symptoms. Recent echocardiogram warrants reassessment.
- New referral received from Dr. Jones on 2023-09-15.
- Patient presents with worsening angina, previously stable on medication.
- Echocardiogram findings show significant stenosis, which may necessitate surgical intervention.
