1What Is the A345 OHIP Code?
What is A345?
A345 is the billing code for a comprehensive consultation service provided by Radiation Oncologists in Ontario, under the OHIP system. This service is typically utilized for newly diagnosed cancer patients to determine the appropriateness of radiotherapy, set intent, target, and fractionation before proceeding with treatment planning.
This code allows for the incorporation of a detailed assessment and enables the consulting physician to prepare a comprehensive report for the referring healthcare provider, addressing the complex needs of oncology patients. Given the necessity for a written referral request and comprehensive patient evaluation, A345 differs from more limited consultation codes.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A346 | Repeat Consultation | Use for the same patient, same physician when consultation requirements are met again within the cycle. | Used for repeated consultations where criteria for a consultation are satisfied again. |
| A745 | Limited Consultation | Use when the consultation scope does not meet comprehensive levels. | Applicable for consultations that are less extensive than those billed under A345. |
| C345 | Consultation for In-patients | Applies to consultations for hospital in-patients. | A345 equivalent for consultations provided within a hospital setting. |
| C346 | Repeat Consultation for In-patients | Similar scenarios as A346 but for hospital in-patients. | Repeated consultation code for use in hospitals similar to C345. |
3Eligibility Requirements
Eligibility Requirements for Billing A345
To bill A345, the consultation must be rendered following a written request from a referring physician, nurse practitioner, or dental surgeon. The consultation should address a case of complexity, seriousness, or require another opinion. A written report summarizing the findings, opinions, and recommendations must be prepared for the referrer.
The consultation request must include:
- Consultant name/specialty, referring professional’s name and billing number, and patient’s details (name, health number).
- Specific services and information relevant to the referral.
- A clearly defined unrelated diagnosis for consultations more frequent than once every 24 months, unless rendered to a hospital in-patient or an Emergency Department patient with the same diagnosis.
4What Your Clinical Note Must Show
Maintain a copy of the consultation request in the patient's record, except where common records exist in hospitals or LTCFs.
- Request must be in writing from the referrer.
- Include referring provider's name and billing number.
- Identify the patient by name and health number.
- Include relevant referral information.
Time must be recorded in the patient’s medical record.
- Start and end time of consultation must be recorded to ensure service is payable.
Prepare a comprehensive written report to the referring professional.
- Include findings, opinions, recommendations.
- Copy should be sent following consultation completion.
5Weak vs. Strong Note Examples
The strong note clearly demonstrates compliance with OHIP requirements by detailing the consultation process, providing a comprehensive report, and recording accurate time entries, unlike the vague weak note.
Consultation performed today. Report was generated and sent.
Consultation performed upon receipt of request from Dr. Smith, today's date. Discussed complexities of patient's new cancer diagnosis and treatment options.
Prepared detailed report including assessment findings, opinion on radiotherapy indication, and treatment recommendations. Report sent to Dr. Smith.
Consultation time started at 10:00 AM and ended at 11:30 AM.
- Clear identification of referring physician and reason for consultation.
- Detailed summary of assessment, findings, and recommendations.
- Precise timing details included.
