1What Is the A245 OHIP Code?
What is A245?
The A245 billing code refers to a consultation in the specialty of Otolaryngology, commonly known as ENT (Ear, Nose, and Throat). This code is specifically used when a consultation is provided by an ENT specialist upon written referral.
Consultations under this code are usually for conditions such as chronic rhinosinusitis that is unresponsive to medical treatment, unilateral hearing loss, pulsatile tinnitus requiring further work-up, and persistent hoarseness in smokers, which could indicate potential malignancy. Additionally, consultations may be requested for assessing surgical options in obstructive sleep apnoea or when evaluating a neck mass of uncertain origin.
A245 is sometimes missed due to confusion with related consultation codes or improperly documented referrals, which are essential for billing this code correctly.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | Varies by case complexity and necessity | Higher fee for complex surgical consultation cases in Otolaryngology. |
| C935 | Special surgical consultation | Varies by case complexity and necessity | Premium rate for complex surgical inpatient consultations in ENT. |
| A246 | Repeat consultation | As needed based on patient's condition and referral | Follow-up consultations within Otolaryngology for the same issue. |
| C245 | Consultation | Same limits as A245 but for hospitalized patients | In-patient equivalent consultation under the same criteria as A245. |
3Eligibility Requirements
Eligibility Requirements
- Frequency Limitations: The A245 code is billable once per two consecutive 12-month periods for the same patient, physician, and diagnosis. Exceptions include billing twice in the same period if the second service is for an inpatient or Emergency Department visit and occurs more than 12 but less than 24 months after the first service.
- Unrelated Diagnoses: If there is a clearly unrelated diagnosis, A245 may be billed once every 12 months.
- Virtual Services: A245 can be billed for consultations rendered via video as A245A per Appendix J, Section 1 guidelines. Telephone consultations are not eligible.
- Hospital In-Patient Equivalent: Use C245 for services provided to in-patients.
4What Your Clinical Note Must Show
Ensure all documentation is thorough and includes:
- Written referral from the referring physician.
- Detailed clinical notes supporting the need for consultation.
- Documentation of virtual care eligibility if billed as A245A.
5Weak vs. Strong Note Examples
The strong note succeeds because it includes specific clinical and diagnostic details, referral source, and a management plan, while the weak note lacks detail and context.
Patient referred for ENT consultation. Reviewed symptoms.
Patient referred by Dr. Smith for chronic rhinosinusitis unresponsive to medical therapy. Detailed examination performed including CT scan review and nasal endoscopy. Discussed possible surgical options after failing medical management. Agreed on treatment plan pending further evaluation results.
- Referral specifies chronic rhinosinusitis.
- Examination details and diagnostic work-up.
- Clear plan of care and patient discussion documented.
