1What Is the A260 OHIP Code?
A260 is the OHIP billing code for a Special Paediatric Consultation, which involves a comprehensive evaluation by a pediatrician. This code is used when consultations require longitudinal attention, often for complex cases or second opinions. Despite the higher reimbursement rate, many practitioners miss billing for A260 due to overlooked documentation requirements, notably the start and stop times of the consultation.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A260 | Special Paediatric Consultation | Commonly used for complex or lengthy cases | Requires 75 minutes of direct contact and detailed records |
| A265 | Standard Paediatric Consultation | Regular consultations not meeting the A260 duration | Standard consultation for less than 75 minutes |
3Eligibility Requirements
To be eligible for billing under code A260, the pediatrician must conduct a Special Paediatric Consultation, which involves meeting the criteria of a standard consultation (A265) and includes at least 75 minutes of direct patient contact. Importantly, the start and stop times must be recorded in the patient's permanent medical record. If the consultation is less than 75 minutes, the service should be billed as a standard paediatric consultation under A265.
4What Your Clinical Note Must Show
The following items must be documented for the A260 billing code:
- Start and stop times of the consultation
- Comprehensive patient notes covering the consultation
5Weak vs. Strong Note Examples
The strong note succeeds because it includes the required start and stop times and details the consultation content. The weak note fails to provide these specifics.
Consulted patient regarding multiple issues. Spent a considerable amount of time discussing treatment options and answering questions.
Start Time: 10:00 AM
End Time: 11:30 AM
Consulted with patient on complex medical issues including asthma management and developmental concerns. Discussed treatment strategies in detail, and answered patient and family questions thoroughly.
- Start and stop times clearly noted
- Detailed patient interaction documented
