1What Is the A116 OHIP Code?
A116 is an OHIP billing code for repeat consultations within critical care medicine. This code is utilized when a patient previously seen by a critical care specialist requires a follow-up consultation after receiving care from another physician. This typically occurs when a patient's condition deteriorates following interval treatment.
A repeat consultation requires a new written request from a referring physician, nurse practitioner, or dental surgeon and focuses on reassessing a patient with the same prior presenting issue.
This service is often missed due to incomplete or absent written consultation requests, leading to claims adjustments to lower assessment fees. Ensuring proper documentation and understanding of criteria are paramount for successful billing.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A710 | Comprehensive critical care medicine consultation | Once per two consecutive 12-month periods | Initial comprehensive consultation in critical care. |
| A715 | Consultation | Once per two consecutive 12-month periods | Standard consultation in critical care. |
| A915 | Limited consultation | Once per two consecutive 12-month periods | Limited consultation with the same $122.00 fee. |
| C116 | Repeat consultation | Unlimited with proper documentation | Repeat consultation for hospital in-patients with the same fee as A116. |
3Eligibility Requirements
For a repeat consultation under code A116 to be eligible for billing:
- A written request, signed by the referring healthcare provider, is mandatory, except in settings with shared medical records, such as hospitals or multi-specialty clinics.
- The consultation must be based on the same diagnosis as the initial consultation, occurring after interval treatment by another physician.
- Repeat consultations are not restricted by the general consultation frequency limits, but each requires fresh referral documentation.
- Virtual delivery is possible via video consultation, billed as A116A. Telephone consultations are not eligible.
Failure to meet these criteria will result in the payable amount being adjusted to a general or specific assessment fee.
4What Your Clinical Note Must Show
Maintain a copy of the written consultation request in the patient's medical record.
- Signed by the referring physician, nurse practitioner, or dental surgeon.
- Exempt in shared record systems like hospitals or multi-specialty clinics.
Ensure the consultation pertains to the same problem and includes recent referral documentation.
- Confirm the patient's diagnosis matches the initial consultation.
- The interval care by another physician must be documented.
5Weak vs. Strong Note Examples
The strong note includes a clear referral source, specific details of the interval care, and proper documentation. The weak note fails by lacking the necessary referral details and supporting documents.
Patient was seen for follow-up. No documentation provided. Referring doctor not indicated.
Patient re-referred for worsening dyspnea. Follow-up requested by Dr. Smith, following initial consultation on March 10, 2023.
Documentation from interval care by Dr. Jones made available.
- Referral letter from Dr. Smith dated May 1, 2023.
- Complete patient chart with diagnosis notes from both initial and interval care.
