1What Is the A136 OHIP Code?
The A136 OHIP billing code is designated for repeat consultations in internal medicine, valued at $123.10. It applies when an internist sees an established patient again for the same medical issue upon a new request from the referring physician, nurse practitioner, or dental surgeon. Typical scenarios include cases of resistant hypertension or evolving thyroid issues that necessitate a specialist's fresh perspective.
It's vital to remember that each repeat consultation requires a new written request to qualify for this specific code. Otherwise, it is downgraded to a general or specific assessment, affecting reimbursement.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A130 | Comprehensive internal medicine consultation | As required | Covers comprehensive internal medicine consultations. |
| A135 | Consultation | As required | For general consultations in internal medicine. |
| A435 | Limited consultation | As required | For limited internal medicine consultations. |
| C130 | Comprehensive internal medicine consultation (Hospital) | Hospital-based | Used for comprehensive consultations for in-patients. |
3Eligibility Requirements
Eligibility for billing A136 relies on a few crucial conditions.
- Each repeat consultation must be initiated by a new written request from the referring physician, nurse practitioner, or dental surgeon.
- Unlike initial consultations, repeat consultations under the A136 code do not count against consultation frequency limits described in GP17.
- This code can be rendered virtually, but only through video, and billed as A136A. Telephone consultations do not qualify.
Additionally, all services must align with general parameters set by the OHIP Schedule of Benefits.
4What Your Clinical Note Must Show
Ensure compliance by providing the following:
- New written request from the referring physician, nurse practitioner, or dental surgeon for each repeat consultation.
- Detailed records of the patient consultation, including any updated findings.
- Evidence of a virtual video delivery when applicable.
5Weak vs. Strong Note Examples
The strong note succeeds by explicitly documenting the written request, updated clinical findings, and specific consultation mode, ensuring compliance with A136 billing requirements. The weak note fails to capture the necessary details.
Patient seen again for ongoing issue. Follow-up requested by GP.
Patient seen again for worsening hypertension. Re-evaluation requested via written request from Dr. Smith, reference number 1024. Adjusted medication regimen. Video consultation performed, consent received.
- Written request visibly documented
- Updated clinical findings recorded
- Clear documentation of video consultation
