1What Is the A186 OHIP Code?
The A186 billing code is used for repeat consultations in neurology settings within Ontario, billed at CAD 125.50. This code is applied when a neurologist needs to reassess a patient for the same medical issue that was the subject of a previous consultation, such as when seizure patterns have changed or a known condition has worsened. Each repeat consultation requires a new written request from the referring physician, nurse practitioner, or dental surgeon. Failure to obtain this written request can result in the service being downgraded to a general or specific assessment.
The code ensures neurologists are compensated for their expertise in situations where there is a need for updated clinical input after the initial consultation. This often involves changes in a patient's condition like tremor progression or demyelinating relapse, warranting further professional evaluation.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A180 | Special neurology consultation | per consultation | Billed for more complex neurology consultations. |
| A185 | Consultation | per consultation | General consultation in neurology. |
| A385 | Limited consultation | per consultation | Used for less comprehensive neurology consultations. |
| A682 | Extended special neurology consultation | per consultation | Billed for extended consultations involving greater complexity. |
3Eligibility Requirements
To be eligible to bill code A186, ensure the following requirements are met:
- Virtual and In-Person Services: A186 can be billed for services provided via video (A186A) but not by telephone, as per Appendix J.
- In-Patient Equivalent: For hospital in-patients, use the corresponding code C186.
- Documentation: A new written request from the referring physician, nurse practitioner, or dental surgeon is mandatory for each repeat consultation.
- Exempt from Frequency Limits: Repeat consultations do not fall under the frequency limits outlined in GP17.
4What Your Clinical Note Must Show
Ensure the following documentation is obtained and maintained for each billing of code A186.
- A new written request from the referring physician, nurse practitioner, or dental surgeon.
- Documentation of the clinical necessity for the repeat consultation.
- Details of the changes in the patient's symptoms or condition warranting the reassessment.
5Weak vs. Strong Note Examples
The strong note clearly documents the clinical need and new referral, while the weak note lacks detail and fails to justify the repeat consultation billing.
Patient seen again for follow-up. No new symptoms noted.
Patient presents with altered seizure activity, experiencing increased frequency and intensity over the past month.
Referral from Dr. Smith requested reassessment due to these changes. New MRI results indicate progression of the disease.
- A new referral note is attached.
- Further tests recommended to reassess treatment plan.
