1What Is the A226 OHIP Code?
A repeat consultation under the A226 code is a follow-up service performed by the same geneticist for the same patient and presenting issue after the patient has received interim care from a different physician. This type of consultation is critical in medical genetics when new test results or an update in a family member's genetic status requires a reassessment. It is crucial as these consultations often address complex genetic profiles that evolve over time.
Geneticists must ensure that a new written request is obtained from the referring physician, nurse practitioner, or dental surgeon for each repeat consultation. This documentation validates the continued necessity of the geneticist's insight into the patient's genetic inquiries. Missing this requirement often leads to underpayment, making it imperative for medical billing staff and physicians to thoroughly document and verify these repeat requests.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A220 | Special genetic consultation | Limited to specific cases requiring in-depth analysis | High-complexity cases demanding comprehensive genetic evaluation. |
| A223 | Extended special genetic consultation | For cases requiring significant time and resources | Used for in-depth follow-up on complex genetic cases. |
| A225 | Consultation | Initial consultation for typical genetic issues | Standard consultation rate for new genetic cases. |
| A325 | Limited consultation | Similar fee and restrictions apply as A226 | Basic consultation service for limited genetic evaluation. |
3Eligibility Requirements
To be eligible for billing under A226, the following criteria must be met:
- A new written request must be issued by the referring physician, nurse practitioner, or dental surgeon.
- Documentation of this request must be maintained in the consulting physician's records unless the consultation occurs in a hospital, long-term care institution, or multi-specialty clinic where common records are maintained.
- The service can be provided virtually via video; telephone consultations do not qualify under the Comprehensive Virtual Care Services category.
- The consultation must involve a follow-up for the same presenting problem after care by another provider.
If these requirements are not met, billing is adjusted to reflect a lower assessment fee, underscoring the importance of strict adherence to these protocols.
4What Your Clinical Note Must Show
Ensure the following documentation is maintained:
- A written request from the referring physician, NP, or dental surgeon.
- Record of the new clinical reason necessitating the repeat consultation.
- Confirmation of prior interval care by another provider.
5Weak vs. Strong Note Examples
The strong note succeeds by explicitly mentioning the new referral and updated clinical details, whereas the weak note lacks this specificity, leading to potential billing issues.
Patient returned for follow-up. No new documentation of referral provided.
Patient seen for repeat consultation: updated genetic testing results discussed.
New referral request received from Dr. Smith, family physician, due to new family history.
- Notes clearly match updated clinical reason.
- Referral documentation included in records.
