1What Is the A156 OHIP Code?
A repeat consultation under the OHIP A156 billing code is an essential tool for endocrinologists who need to follow up with a patient for the same ongoing issue after they have been seen by another physician. For instance, an endocrinologist might see a patient for thyroid or pituitary issues based on new referral requests, often due to changes in hormone levels after interim treatment by a family physician.
A156 allows for a necessary revisit without the standard frequency limitations imposed on initial consultations, provided the correct procedural steps are followed. Endocrinologists must ensure they have a new written referral to qualify for this code. Failing to meet this requirement can result in the service being downgraded to a general assessment.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A150 | Comprehensive endocrinology consultation | Eligible once every two consecutive 12 month periods unless criteria for repeat is met. | A broad, initial assessment requiring extensive review. |
| A155 | Consultation | Limited to once every two consecutive 12 month periods unless conditions as described in GP17-GP18 are met. | General consultation for evaluation of endocrine diseases. |
| A255 | Limited consultation | As needed, subject to same conditions as general consultations. | Brief assessment with less complexity. |
| C150 | Comprehensive endocrinology consultation | Eligible as per conditions outlined for comprehensive services in the hospital. | In-depth endocrinology consultation for inpatients. |
3Eligibility Requirements
To be eligible for billing under A156, the following criteria must be fulfilled:
- A written request signed by the referring physician, nurse practitioner, or dental surgeon must be kept in the consulting endocrinologist's medical records except when the consultation occurs in a hospital, long-term care institution, or multi-specialty clinic with shared medical records.
- A156 consultations can be rendered both in-person and virtually. When delivered virtually, they must be done via video, as telephone consultations do not qualify.
- Each repeat consultation must address the same presenting issue, accompanied by a new referral.
- Consultations involving the same diagnosis are normally limited, but repeat consultations are exempt from frequency restrictions if the procedural requirements are met.
4What Your Clinical Note Must Show
Ensure the following documents are in place to support A156 billing:
- A written request from the referring physician, kept in the medical record.
- Verification that the repeat consultation addresses the same issue as the initial assessment but with a new referral.
- Appropriate documentation if consultation occurred virtually, ensuring video-only format.
5Weak vs. Strong Note Examples
The strong note provides specific details about the original consultation, the interim care given, and changes in the patient’s condition, aligning with OHIP requirements, while the weak note lacks essential details.
Patient seen for repeat consultation. No detailed reference to the original issue or interval treatment.
Detailed note includes:
Patient revisited for thyroid dysfunction, initially evaluated 6 months ago. Referred back by Dr. Smith after patient experienced altered hormone levels post-initial GP management.
- Specific mention of the initial diagnosis and treatment course.
- Inclusion of new referral details and updates on the patient’s condition.
