1What Is the A206 OHIP Code?
What is the A206 OHIP Billing Code?
The A206 billing code is designated for repeat consultations in the field of obstetrics and gynaecology under OHIP in Ontario, Canada. It caters specifically to situations where a patient requires further evaluation for the same problem within the specialty — for example, unresolved abnormal bleeding or complications during pregnancy that necessitate additional assessment. The code allows specialists to address ongoing concerns efficiently while maintaining the standard of care.
This code differs from an initial consultation because it addresses the same presenting issue but requires a new written request from a referring provider. It is crucial for ensuring continuous and comprehensive management of the patient's obstetric or gynaecological conditions. Notably, the collection of cervical cancer screening specimens during a pelvic examination is included within the fee structure, which underscores the holistic approach needed in these settings.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | as required | Higher complexity consultation under Obstetrics and Gynaecology at $194.65. |
| C935 | Special surgical consultation | as required | Same service as A935 but for hospital in-patients at $194.65. |
| A205 | Consultation | as required | Standard consultation in Obstetrics and Gynaecology at $134.25. |
| C205 | Consultation | as required | Standard consultation for hospital in-patients at $134.25. |
3Eligibility Requirements
Eligibility and Documentation
To bill OHIP using the A206 code, the following requirements must be satisfied:
- New Written Request: Each repeat consultation necessitates a new written request from a referring physician, nurse practitioner, or dental surgeon. This must be retained in the consulting physician's medical record unless provided in a hospital or long-term care setting where common records are utilized.
- Virtual Care Eligibility: A206 can be billed for video consultations but not telephone consultations.
- Clinical Precondition: The repeat consultation must follow care by another physician indicating the same problem as the initial consultation.
It is important to note that these repeat consultations are excluded from the general frequency limits applicable to other consultations, thereby affording more flexibility in patient management.
4What Your Clinical Note Must Show
Ensure all paperwork is complete and on file to support billing claims.
- A copy of the written request from the referring clinician is on file.
- Medical records indicate the consultation’s association with the same problem.
- If conducted virtually, ensure video consultation documentation confirms methodology.
5Weak vs. Strong Note Examples
The strong note is successful because it specifically outlines the reasons for the repeat consultation and details the care provided, including any examination performed. The weak note fails to provide context or specific medical actions, making it insufficient for billing purposes.
Patient returns for follow-up. Discussed treatment plan.
Repeat consultation for unresolved abnormal uterine bleeding.
Reviewed current symptoms and response to treatment since initial consultation.
Plan of action: Discussed options for further investigation and potential surgical intervention.
- Conducted pelvic examination with cervical specimen collection.
- Discussed next steps with patient including follow-up schedule.
