1What Is the A185 OHIP Code?
What is the A185 Billing Code?
The A185 code represents a standard neurology consultation within Ontario's OHIP system, billed at CAD 225.55. It is typically applied for cases warranting specialist evaluation such as a new headache, a first seizure, or suspected multiple sclerosis after an initial episode. Neurology consultations under A185 allow specialists to thoroughly assess conditions that require a detailed diagnostic process.
It's important to correctly identify when A185 applies. Frequently, cases with seemingly complex needs may warrant a different code, such as A180 for more in-depth evaluations. Misidentification can lead to improper billing or missed opportunities for appropriate care.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A180 | Special neurology consultation | Fee schedule: $342.25 | For cases requiring more intensive evaluation than those under A185. |
| A186 | Repeat consultation | Fee schedule: $125.50 | For follow-up consultations within the neurology specialty. |
| A385 | Limited consultation | Fee schedule: $125.50 | Used when a concise evaluation is sufficient. |
| A682 | Extended special neurology consultation | Fee schedule: $442.40 | For highly complex cases requiring extensive consultation. |
3Eligibility Requirements
Eligibility for A185 Billing
The A185 code may be used once per patient for the same diagnosis every two consecutive 12-month periods, unless a second occurrence happens in a hospital inpatient setting or emergency department beyond 12 but less than 24 months from the first. A185 is also billable every 12 months if a clearly defined unrelated diagnosis arises.
- Virtual Delivery: The A185 consultation may be conducted via video and billed as A185A. Telephone consultations are not eligible under this code.
- Hospital In-patient Equivalent: When the consultation is rendered in an inpatient hospital setting, use C185.
Ensure all eligibility conditions are met to avoid denial or reduced rates.
4What Your Clinical Note Must Show
Complete and accurate records are imperative for each consultation billed under A185.
- Referral details including referring physician and reason for consultation.
- Comprehensive history and physical examination findings.
- Investigations ordered or reviewed and their relevance.
- Management plan and any recommended follow-up appointments.
5Weak vs. Strong Note Examples
The strong note provides a detailed clinical assessment and management strategy, demonstrating the complexity and necessity of the consultation, while the weak note lacks comprehensive information and specificity.
Patient referred for headache. Discussed possible causes. Advised follow-up.
Patient referred by Dr. Smith for evaluation of new onset severe headaches with photophobia over the last month.
Comprehensive history reviewed including past migraine history; physical exam revealed no focal deficits.
Differential diagnosis includes migraine, tension headache, or possible secondary causes requiring imaging.
Investigations ordered: MRI head. Patient advised to follow-up in two weeks with results. Initiated trial of topiramate pending investigation outcomes.
- Clear referral purpose and relevant history.
- Detailed physical exam supporting the consultation complexity.
- Defined differential diagnosis matching the presented symptoms.
- Documented patient management plan.
