1What Is the A285 OHIP Code?
The A285 code under OHIP represents a consultation service specifically within the specialty of pathology. It is predominantly utilized by pathologists in the office or outpatient clinic settings and involves evaluating patients for assessments such as apheresis or resolving complex laboratory findings.
This service is distinct due to its hands-on consultative nature, as opposed to mere review and reporting on specimens. The consultation acts upon a formal written request from a referring healthcare professional, emphasizing complexity, seriousness, or the need for a secondary opinion.
Frequently, these consultations are missed when practitioners fail to meet the distinct eligibility criteria, particularly those around documentation and timing of referral requests, thereby resulting in a lesser assessment fee instead.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A286 | Limited Consultation | As needed per patient case specifics | Used for smaller scope consultation services within Laboratory Medicine. |
| A580 | Comprehensive Internal Medicine Consultation | Based on service requirements | Higher complexity consultation suitable for comprehensive internal medicine cases. |
| A585 | Diagnostic Consultation | As dictated by patient condition | Consultation aimed at specific diagnostic inquiries. |
| A586 | Repeat Consultation | Per eligibility guidelines | Follow-up consultation where additional expertise is necessary. |
3Eligibility Requirements
Eligibility Criteria for A285 Consultation
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A written consultation request must be made by a physician, nurse practitioner, or dental surgeon, and arise from the complexity, seriousness, or uniqueness of the patient's case.
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Documentation: Maintain a copy of the signed consultation request in the patient’s medical record, which must include the consultant and referring practitioner's names and billing numbers, along with the patient's identifications.
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The consultation must involve an assessment leading to a written report containing findings and recommendations to the referrer.
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Virtual Consults: A285 can be rendered virtually (video only) using the A285A code but not via telephone.
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Frequency Limits: Maximum of one consultation per two 12-month periods for the same patient and diagnosis, unless otherwise specified by hospital or Emergency Department scenarios.
4What Your Clinical Note Must Show
For billing purposes, the following documents are critical:
- A written consultation request from the referring practitioner outlining the consulting physician and purpose.
- Complete consultation report detailing findings, opinions, and recommendations sent back to the referrer.
- Record start and end times of consultation on patient's permanent medical record.
5Weak vs. Strong Note Examples
The strong note succeeds by including complete documentation as required by OHIP, emphasizing clarity in communication and recording time specifics, thus ensuring full compliance.
The referral was from a physician. No start or end times recorded.
A summary of patient discussion sent to the referring physician.
Consultation request from Dr. Smith on 2023-07-01, 14:00, concerning apheresis evaluation for patient #123456789.
Consultation began at 14:30 and concluded at 15:15.
Findings discussed with patient were detailed in a written report sent to Dr. Smith, including diagnostic conclusions and further recommendations for follow-up.
- Specific request identification: patient, referring physician, reason for consult.
- Detailed time recording of service delivery.
- Comprehensive report communicated back to referrer.
