1What Is the A246 OHIP Code?
The A246 billing code refers to a repeat consultation provided by ENT specialists in Ontario. It is applicable when a patient is referred back to the same consultant for the same issue, such as persistent hearing loss, recurrent sinusitis, or a changing neck mass after receiving interim care from another physician.
Given the nature of ENT issues, repeat consultations allow specialists to evaluate the progress of a treatment plan that might require ongoing adjustments based on patient response or new clinical findings. A common example can include unresolved symptoms or the emergence of new diagnostic cues requiring reevaluation.
This code can be overlooked when physicians mistakenly think the original consultation limits apply or when there's inadequate documentation, particularly if the new referral isn't properly secured and documented.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | Limited by consultation guidelines | Specific to surgical scenarios requiring advanced discussion. |
| C935 | Special surgical consultation | Limited by consultation guidelines | Surgical setting equivalent. |
| A245 | Consultation | Limited by consultation guidelines | Initial consultation for ENT issues. |
| C245 | Consultation | Limited by consultation guidelines | Hospital inpatient equivalent for initial consultations. |
3Eligibility Requirements
To be eligible for billing the A246 code, the following conditions must be met:
- A new written request for the consultation, signed by the referring physician, nurse practitioner, or dental surgeon, must be kept on file.
- This requirement is waived if the consultation takes place in a hospital, long-term care institution, or multi-specialty clinic with collective records.
- The repeat consultation must involve the same presenting problem and the same physician.
- This service can be delivered virtually, but only via video, not by telephone.
4What Your Clinical Note Must Show
Ensure that the following is documented to support the billing of A246:
- A written request signed by the referring provider.
- A note confirming a new clinical evaluation for the same problem.
- Storage of documentation in the patient's medical record unless in a multi-physician setting with common records.
5Weak vs. Strong Note Examples
The strong note succeeds due to its specific references to clinical observations and actions taken, whereas the weak note lacks detail and specific references to the patient's clinical pathway or changes.
Patient seen for repeat consultation. Persistent issues noted. Advised further management.
Patient returns for a repeat consultation regarding persistent hearing loss.
Referral from Dr. Smith noted; patient's symptoms persist post-intervention by Dr. Lee.
Evaluated changes since initial assessment, identifying poor response to treatment.
- Documented new observations and consulted on alternative treatment options.
- Updated care plan entered into patient’s record with a detailed note of ongoing issues.
