1What Is the A231 OHIP Code?
What is A231?
The A231 code is used to bill for neuro-ophthalmology consultations in Ontario, Canada, under OHIP. This code is specific to consultations involving neuro-ophthalmological disorders and must be rendered by an ophthalmologist with fellowship training in neuro-ophthalmology.
It's frequently missed due to its stringent documentation requirements, which specify that at least four detailed components must be included in the exam. These include a detailed pupillary examination, extraocular motility, ocular alignment testing, neurological examination, fundus examination, visual field test analysis, and review of diagnostic imaging studies.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | Restricted to specific surgical consultations in ophthalmology. | A935 refers to special surgical consultations for complex surgical cases within the Ophthalmology specialty. |
| C935 | Special surgical consultation | Restricted to specific surgical consultations in ophthalmology. | C935 pertains to in-patient special surgical consultations provided by ophthalmologists. |
| A235 | Consultation | General ophthalmological consultations as needed. | A235 is used for general consultations in ophthalmology, often for cases not requiring specialization. |
| A236 | Repeat consultation | Can be billed following an initial consultation when necessary. | A236 is for repeat consultations in ophthalmology where ongoing assessment is required. |
3Eligibility Requirements
Eligibility Requirements
To qualify for payment under the A231 billing code, the following criteria must be met:
- Consultation Requirements: A231 is only payable when the consultation involves a neuro-ophthalmological disorder, and the service is provided by an ophthalmologist with neuro-ophthalmology fellowship training.
- Documented Examination Elements: At least four of the following elements must be documented:
- Detailed pupillary examination, including pharmacological testing if applicable
- Detailed extraocular motility examination
- Ocular alignment testing
- Partial or complete neurological examination
- Detailed examination of the fundus
- Analysis of formal visual field test(s)
- Analysis of pertinent diagnostic imaging studies
- Frequency of Services: The same physician may only render this service once per two consecutive 12-month periods to the same patient for the same diagnosis, with allowances for certain exceptions involving hospital inpatients or emergency department patients.
4What Your Clinical Note Must Show
1Consultation Documentation
A comprehensive report must be prepared following the consultation.
- Include findings, opinions, and recommendations.
- A copy of the written referral request must be kept, indicating the consultant's name, the referring physician or nurse's information, and the patient's details.
5Weak vs. Strong Note Examples
The strong note succeeds because it details the specific components of the examination and how they apply to the patient, while the weak note lacks specific documentation of required elements.
❌ Weak Note
Consultation completed for vision issues. Discussed treatment options.
✓ Strong Note
Comprehensive neuro-ophthalmology consultation completed.
Tests performed: Pupillary exam, extraocular motility, neurological evaluation, fundus examination.
- Patient referred due to headaches and vision disturbances.
- Findings indicated potential optic nerve involvement.
6Common Reasons This Code Is Missed
1
Incomplete Examination Documentation
Failure to document at least four mandatory elements can result in rejected claims.
2
Inappropriate Consultation Request
Consultations not initiated by a valid referral or without a proper written request may not be eligible for billing.
3
Incorrect Specialty Requirements
The service must be rendered by a neuro-ophthalmologist with proper fellowship training.
Document A231 correctly — every time
Empathia's templates automatically structure your notes to capture every required element for audit-proof billing.
8Frequently Asked Questions
How often can A231 be billed for the same patient?
A231 can be billed once per two consecutive 12-month periods per patient for the same diagnosis, with specific allowances for hospital inpatients or emergency department visits.
What distinguishes a neuro-ophthalmology consultation from other ophthalmological consultations?
It requires specialized examination techniques specific to neurological disorders affecting vision, administered by a neuro-ophthalmologist.
What should a referring physician include in the consultation request for A231?
The request should have the consultant's name, referring physician's details, patient information, and relevant clinical details.
Under what conditions can A231 be billed more than once in two years?
It can be billed a second time if the patient is a hospital inpatient or in the emergency department, and it is more than 12 but less than 24 months after the first consultation.
Who is eligible to provide an A231 consultation?
An ophthalmologist with fellowship training in neuro-ophthalmology is required to conduct and bill this consultation.
What might prompt a referral for a neuro-ophthalmology consultation?
Unusual visual symptoms potentially linked to neurological disorders, such as severe headaches with visual changes, typically prompt such referrals.
Why is documentation of examination components critical for A231 billing?
At least four specific examination components must be documented to fulfill billing criteria and demonstrate the thoroughness required for diagnosing neuro-ophthalmological conditions.
What should be included in the consultation report sent back to the referring physician?
The report should cover findings, opinions, and any recommendations following the consultation.
Disclaimer: This article is intended as a general educational resource for physicians and billing staff. It does not constitute billing advice or a definitive interpretation of the OHIP Schedule of Benefits. Always verify current billing codes, eligibility criteria, and documentation requirements directly against the official Schedule of Benefits or consult with a qualified medical billing specialist.
