1What Is the A195 OHIP Code?
A195 is a billing code used by psychiatrists to claim fees for providing consultation services under OHIP in Ontario. This code is representative of an in-depth evaluation, typically involving patients with complex psychiatric conditions that have not responded to primary care. Common scenarios requiring an A195 include assessments of differential diagnoses such as bipolar versus unipolar disorders, or complex medication reviews where side effects and previous treatment failures need to be critically appraised.
Although frequently billed, it is vital to distinguish when A195 applies versus situations where a more comprehensive consultation applies, such as A190 for extended evaluations. For billing A195, it doesn't reach the minimum 75-minute direct contact threshold required for A190. This distinction can often be overlooked, leading to missed opportunities for appropriate reimbursement.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A190 | Special psychiatric consultation | As defined by psychiatric admission or necessity. | Requires minimum 75-minute direct contact, for more complex cases. |
| A196 | Repeat consultation | As needed, within defined periods. | Used for follow-up consultations. |
| A395 | Limited consultation | As needed for brief assessments. | Intended for more straightforward or limited assessment needs. |
| A695 | Neurodevelopmental consultation | For eligible cases involving specific developmental assessments. | Used in assessments related to neurodevelopmental conditions. |
3Eligibility Requirements
Eligibility Requirements
- Billing Frequency: A195 can be billed once per two consecutive 12-month periods for the same patient, same physician, and the same diagnosis. Where applicable, a second billing is permitted if rendered to a hospital inpatient or an Emergency Department patient, but this must be over 12 but less than 24 months after the first service.
- Unrelated Diagnosis: If the diagnosis is clearly unrelated, A195 can be billed once every 12 months.
- Mode of Delivery: A195 may be billed virtually as A195A, but only via video conferencing. Telephone consultations are not eligible for this code.
- Special Considerations: Claims must be submitted with the appropriate prefix codes when rendered in specific settings, such as hospitals or emergency departments.
4What Your Clinical Note Must Show
Document the patient's symptoms, prior treatments, and the purpose of the consultation.
- Comprehensive clinical history.
- Referring physician's details.
- Provisional diagnosis.
Specify whether the service was delivered in-person or via eligible virtual platforms.
- Platform details for virtual consultations.
- Verification of video use if billed as A195A.
5Weak vs. Strong Note Examples
The strong note succeeds by providing a detailed account of both clinical and administrative elements that justify the consultation. It clearly outlines the procedures undertaken and decisions made, whereas the weak note lacks specificity and depth.
Patient seen for consultation. Discussed symptoms and treatment options.
Comprehensive consultation conducted on a 45-year-old patient for evaluation of treatment-resistant depression. The patient has not responded to two prior antidepressant classes. Conducted differential diagnostic evaluation to rule out bipolar disorder. Previous medication trials and side effects were reviewed and documented. A detailed treatment plan was formulated, including referral for psychotherapy.
- Documented medication history.
- Differential diagnosis process.
- Formulated a detailed care plan.
