1What Is the A196 OHIP Code?
The A196 billing code represents a repeat psychiatric consultation for cases where continuous monitoring or reevaluation is required due to an ongoing or emerging condition. It applies when a psychiatrist reassesses a patient following an initial consultation based on a renewed written request from a referring provider. This can occur if, for example, depression does not respond to multiple trials of treatment or new risk concerns arise. This service requires a detailed review and formulation based on a new healthcare provider's request.
Unlike initial consultations, repeat consultations necessitate a specific reason for reevaluation, documented clearly through a written request. Failure to secure this necessary documentation may lead to the service being adjusted to a general or specific assessment, affecting reimbursement.
The service is notable for its ability to be performed virtually via video, fitting modern telehealth practices, though telephone consultations are not eligible under this code.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A190 | Special psychiatric consultation | Varies | A higher-level consultation for complex psychiatric conditions. |
| A195 | Consultation | Initial | Comprehensive assessment for new referrals. |
| A395 | Limited consultation | Varies | Focused assessment for less complex cases. |
| A695 | Neurodevelopmental consultation | Varies | In-depth consultation for developmental disorders. |
3Eligibility Requirements
The A196 code's eligibility criteria revolve around securing a new written request from a referring physician, nurse practitioner, or dental surgeon each time the service is provided. Repeat consultations are not bound by the general frequency limitations for initial consultations found in GP17.
To bill A196, ensure adequate documentation accompanying the repeat consultation. It must detail the renewed need for assessment, identify changes in the patient's condition, or update the treatment plan. The requested service must reflect a legitimate necessity distinct from previous encounters and comply with the standards outlined in the OHIP Schedule of Benefits.
4What Your Clinical Note Must Show
Each repeat consultation requires a renewed written request from the referrer.
- Must come from a physician, nurse practitioner, or dental surgeon.
- Clearly state the reason for repeat consultation.
5Weak vs. Strong Note Examples
The strong note succeeds by providing thorough documentation of the referral request, detailed clinical evaluation, and justification for the repeat consultation, which ensures compliance with billing requirements. The weak note lacks these critical elements, risking a billing adjustment.
Patient returned for assessment. No detailed request on file. Evaluated mood swings.
Patient re-evaluated per referring physician's renewed request. The patient's depression has not improved with two separate treatment trials. New mood disorder features and risk of self-harm require psychiatric expertise.
- Includes referrer's written request
- Details of past treatment and current changes
- Documented clinical findings and discussions
