1What Is the A256 OHIP Code?
A256 is an OHIP billing code specifically for special assessments requested by optometrists and performed by ophthalmologists. Typically, this service is utilized when an optometrist identifies an issue like a lesion, increased intraocular pressure, or a field defect during a routine eye examination and requires the expertise of an ophthalmologist for a detailed assessment.
This specialized assessment allows for a comprehensive evaluation of the patient’s condition to determine the appropriate course of action. The assessment addresses concerns that may not be adequately managed by the optometrist alone, ensuring timely and specialized care for the patient.
Physicians often overlook this billing code due to unfamiliarity with its specific referral origins or misunderstanding the need for documented start and stop times, which are crucial for compliance and payment eligibility.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | No fixed limit, follows consultation rules | Used for special surgical consultations within ophthalmology. |
| C935 | Special surgical consultation | No fixed limit, follows consultation rules | Similar to A935 but listed separately under schedule categories. |
| A231 | Neuro-ophthalmology consultation | No fixed limit, follows consultation rules | Focuses specifically on neuro-ophthalmological conditions such as optic neuritis. |
| A235 | Consultation | No fixed limit, follows consultation rules | General consultation code for initial patient evaluations. |
3Eligibility Requirements
The service under code A256 is eligible for billing once every 24 months per patient per physician. It is important to record the start and stop times of the assessment in the patient’s permanent medical record to qualify for payment. A256 can be rendered virtually but only via video (billed as A256A); telephone consultations are not covered under this service.
This code must adhere to documentation and time recording guidelines as outlined in the General Preamble GP7. Practitioners should familiarize themselves with these stipulations to ensure compliance and reimbursement.
4What Your Clinical Note Must Show
Mandatory recording of start and stop times in patient records.
- Record exact start time of the assessment
- Record exact stop time of the assessment
- Ensure detailed notes are included in the medical record
5Weak vs. Strong Note Examples
The strong note is successful due to its detailed patient assessment documentation and accurate recording of the consultation times. The weak note fails to provide sufficient detail and lacks time records necessary for compliance.
Patient seen for optometrist-referred issue. Discussed treatment options.
Patient referred by optometrist following routine exam identifying increased intraocular pressure.
Details of examination reveal potential glaucoma; plan includes further testing.
Consultation times recorded: Start 14:05, Stop 15:10.
- Full documentation of referred issue from optometrist
- Specific examination findings with clinical impressions
- Complete time recording as per billing policy
