1What Is the A275 OHIP Code?
The A275 billing code under OHIP is used for limited consultations in infectious diseases. This code is typically employed for a single, focused question related to infectious diseases, such as determining the choice of an antibiotic, interpreting a positive serology test, or evaluating a travel-related exposure.
Limited consultations are intended to be less demanding in terms of time compared to full consultations and are used when the scope of the consultation is narrow, as delineated by the referring physician’s request.
This code is commonly missed because physicians may not differentiate between full and limited consultations or may not maintain accurate records to support the appropriate billing of a limited consultation.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A460 | Comprehensive infectious disease consultation | Refer to the Schedule or Preamble | A comprehensive evaluation compared to a limited consultation, often encompassing a broader diagnostic work-up. |
| A465 | Consultation | Refer to the Schedule or Preamble | Standard consultation falling under the infectious disease specialty, broader than A275. |
| A466 | Repeat consultation | Refer to the Schedule or Preamble | Follow-up assessments after initial consults, denoting continuity in patient care. |
| C275 | Limited consultation | Refer to the Schedule or Preamble | Same as A275 but for hospital in-patients, adjusted for in-patient setting requirements. |
3Eligibility Requirements
To be eligible for billing under A275 for a limited consultation in infectious diseases, a physician must adhere to the following requirements:
- The consultation must be requested in writing by a referring physician, nurse practitioner, or dental surgeon in relation to an insured procedure.
- The same diagnosis limits the billing occurrence to one service per two consecutive 12-month periods, unless it is for a clearly different diagnosis.
- A275 can only be billed as a 'VIDEO ONLY' service for virtual care and not by telephone.
- All consultations must meet the required criteria, including the necessary elements of a specific assessment.
Failure to comply with these specifications may result in the service fee being adjusted to a lesser amount.
4What Your Clinical Note Must Show
Accurate and thorough documentation is critical for A275 billing. Ensure that:
- The consultation request is documented in writing from the appropriate referring professional.
- Time spent on the consultation should be recorded precisely in the patient’s permanent medical record.
- Purpose of consultation and interpretation provided must be clearly noted.
5Weak vs. Strong Note Examples
The strong note succeeds because it provides clear documentation of the referral’s purpose, includes detailed clinical reasoning, and records precise times, ensuring compliance with OHIP billing standards. The weak note lacks detail and specific documentation.
Patient presented with query about positive serology. Discussed briefly and advised further testing.
Received referral to evaluate a positive serology test in the context of recent travel exposure. Reviewed patient's history, discussed potential implications, and recommended specific antibiotic treatment.
Documented in detail: Start time 10:00 AM, end time 10:30 AM.
- Referring provider is clearly identified.
- Specific clinical question and recommendations are detailed.
- Start and stop times are clearly recorded.
