1What Is the A266 OHIP Code?
The A266 OHIP billing code is designated for repeat pediatric consultations in Ontario. This code is used when a pediatric patient returns to the same specialist for the same unresolved issue, such as stalled developmental progress or recurrent symptoms that the initial consultation did not resolve. Another common scenario is growth faltering that persists despite intervention.
To bill under A266, a new written request from the referring physician, nurse practitioner, or dental surgeon is required, distinguishing it from general reassessments. This request is essential for validating the need for ongoing consultation due to complex or unresolved issues.
Often, repeat consultations are missed due to a lack of this essential written request or misclassification as a simple re-assessment. Ensuring proper documentation and understanding the procedural distinctions is crucial for correct billing.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A260 | Special paediatric consultation | Limited by consultation frequency limits | Used for initial complex consultations requiring additional expertise. |
| A265 | Consultation | Limited by consultation frequency limits | Standard consultation for new patients or new issues. |
| A565 | Limited consultation | Limited by consultation frequency limits | For brief and limited scope consultations. |
| A662 | Extended special paediatric consultation | Limited by consultation frequency limits | For particularly complex cases or lengthy consultations. |
3Eligibility Requirements
To bill for a repeat consultation under A266, the following must be adhered to:
- New Written Request: A new request from the referring physician, nurse practitioner, or dental surgeon is mandatory.
- Video Only: If delivering virtually, the service must be via video as telephone consultations do not qualify.
- Hospital In-Patient Equivalent: Use C266 for services provided to hospital in-patients.
Ensure compliance with the above requirements to avoid billing adjustments.
4What Your Clinical Note Must Show
To ensure compliance when billing A266, documentation must include the following:
- A new written request from the referring physician, nurse practitioner, or dental surgeon.
- Evidence of video consultation for virtual visits.
- Detailed notes on the continuity and justification of care regarding the original issue.
5Weak vs. Strong Note Examples
The strong note succeeds because it provides clear evidence of ongoing issues, references the necessity of consultation per a new referral, and thoroughly documents the encounter details. The weak note lacks specificity and fails to justify the need for repeat consultation billing.
The child was seen again for a follow-up. Discussed issues with the parent. No new plan was formulated.
Follow-up consultation with returning patient, initially consulted for developmental delay.
Reviewed developmental milestones with parent. Child showing continued signs of delay.
Consultation done as per new written request from referring pediatrician due to lack of resolution.
- Documented specific developmental concerns.
- Included the date and details of the new referral request.
