1What Is the A235 OHIP Code?
Ophthalmology consultations, billed under OHIP code A235, are crucial first specialist opinions provided upon referral for cases of unexplained visual loss, suspicious optic discs, or intraocular inflammation. This code facilitates the assessment from a qualified ophthalmologist, providing essential advice on complex or obscure visual conditions.
The consultation must be initiated by a written request from a referring physician, nurse practitioner, or dental surgeon. These consultations are often missed when the documentation does not meet specific OHIP requirements or the frequency limits are overlooked.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | Eligibility criteria as per the specific surgical need. | Consultations with a surgical component, billed at a higher rate for complex cases. |
| C935 | Special surgical consultation | Eligibility specific to surgical cases and location. | Hospital-related surgical consultations with increased complexity. |
| A231 | Neuro-ophthalmology consultation | Based on neurological involvement in ophthalmology cases. | Consultation services involve neuro-visual conditions, requiring higher expertise. |
| A236 | Repeat consultation | As needed for follow-ups exceeding standard consultation limits. | Used for repeat assessments when ongoing assessment is required. |
3Eligibility Requirements
Eligibility Criteria
- Referral Requirement: A written request for consultation from a physician, nurse practitioner, or dental surgeon is mandatory.
- Frequency Limits:
- One service per patient diagnosed with the same condition every two consecutive 12-month periods.
- Two services are permitted for hospital inpatients or ED patients, more than 12 but less than 24 months apart.
- For unrelated diagnoses, one service every 12 months is allowed.
- Non-Payable Situations:
- When the request for referral is generated post-service by the consulting physician.
- If the service rendered is after a previous consultation for the same diagnosis requiring ongoing management not resulting from a new referral.
4What Your Clinical Note Must Show
Maintain detailed and compliant records for all consultations.
- Ensure a signed written request from a referring provider is retained.
- Record patient and consultant identification, as well as pertinent diagnosis information.
- Include the consultation request details such as consultant's specialty and service required.
- Document the time spent on consultations.
5Weak vs. Strong Note Examples
The strong note succeeds by including a clear referral source, detailed service notes, and compliant documentation practices, while the weak note lacks sufficient detail to meet OHIP standards.
Consultation completed with Dr. Smith. No referral document attached.
Consultation based on referral by Dr. Jones (Billing#: 123456), assessing patient John Doe (Health#: 9876543210).
Referral request dated 2023-07-10 indicates need for evaluation of suspicious optic disc. Consultation performed and detailed report sent to Dr. Jones on 2023-07-12, with findings and treatment recommendations.
- Written referral attached
- Precise referral details recorded
- Consultation time from 10:00 to 10:45 recorded.
