1What Is the A223 OHIP Code?
What is the A223 Billing Code?
The A223 billing code within the OHIP system applies to an 'Extended Special Genetic Consultation.' It is designed specifically for medical genetics and genomics specialists who require more than 90 minutes of direct, face-to-face contact with a patient, with or without family. Often utilized in situations involving complex family histories or the drawing of multi-generational pedigrees, this extended consultation aims to provide in-depth counseling on testing options.
This extended consultation often includes the assessment of complicated genetic concerns that cannot be addressed in shorter appointment durations. It is vital for cases where detailed exploration of genetic testing and implications occurs. Be aware that failing to meet documented time requirements can lead to underpayment.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A220 | Special genetic consultation | As needed, with typical limits | A consultation in genetics not requiring the extended time component. |
| A225 | Consultation | As needed, with typical limits | A general consultation involving a detailed assessment of the patient's condition. |
| A226 | Repeat consultation | As needed, with typical limits | A repeat assessment of a previously consulted condition. |
| A325 | Limited consultation | As needed, with typical limits | A brief consultation for less complex cases. |
3Eligibility Requirements
Eligibility Requirements
The A223 code is billable under the following conditions:
- The consultation must be requested in writing by a referring physician, nurse practitioner, or dental surgeon. This request must be documented in the consulting physician's medical records.
- The consultation involves at least 90 minutes of direct contact with the patient or family, exclusive of other billable services.
- The start and end times of the service must be clearly recorded in the patient's permanent medical record.
- Frequency limits:
- One service per two consecutive 12-month periods for the same patient and diagnosis.
- Two services per two consecutive 12-month periods if the second is conducted as a hospital inpatient or Emergency Department encounter more than 12 but less than 24 months after the first for the same diagnosis.
- One service every 12 months for clearly unrelated diagnoses.
A223 can be rendered virtually via video and still be eligible for reimbursement.
4What Your Clinical Note Must Show
Thorough documentation is crucial for A223 billing compliance.
- Record start and stop times of the consultation.
- Include a copy of the written request for the consultation by the referring professional.
- Document the patient's name and health number.
- Keep a detailed account of the findings, opinions, and recommendations shared.
5Weak vs. Strong Note Examples
The strong note includes detailed documentation of the consultation activities, specific times, and referral details, which are all critical for billing compliance. The weak note lacks time records and comprehensive consultation details.
Consulted with patient and family for genetic concerns. Discussed possible tests.
Conducted extended genetic consultation with patient and three family members. Examined detailed family history and constructed a multi-generational pedigree. Provided in-depth counseling on testing options.
- Start time: 09:00
- End time: 11:00
- Referral request from Dr. Smith (Referring Physician ID: 12345)
