1What Is the A346 OHIP Code?
What is A346?
A346 is an OHIP billing code for repeat consultations in radiation oncology. This service is rendered when a patient, previously treated by a radiation oncologist, presents with issues related to the same malignancy after receiving interval care by another physician. A typical scenario involves reassessing a patient for re-irradiation when symptoms recur at a previously treated site. Such consultations necessitate a new, written referral.
Although commonly required in managed oncologic pathways, repeat consultations are often missed due to oversight in obtaining the necessary new written referral or insufficient documentation indicating interval care by another physician. Ensuring all conditions are met is critical for accurate billing.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A345 | Consultation | One service per two consecutive 12 month periods; exceptions apply | A general consultation by a radiation oncologist. |
| A745 | Limited consultation | Subject to applicable limitations | A shorter, limited consultation in radiation oncology. |
| C345 | Consultation (Hospital In-patient) | One service per two consecutive 12 month periods; exceptions apply | Consultation for in-patients by a radiation oncologist. |
| C346 | Repeat consultation (Hospital In-patient) | No specific frequency limits, if criteria met | Repeat consultation for in-patients by a radiation oncologist. |
3Eligibility Requirements
Eligibility Requirements for A346
To qualify for billing the A346 code, several criteria must be fulfilled:
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Written Referral: A repeat consultation necessitates a new written request from the referring physician, nurse practitioner, or dental surgeon. This must be kept in the consulting physician's medical record unless the consultation occurs in a facility with common records.
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Interval Care: The patient must have received care for the same issue by another physician between the initial and repeat consultations.
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Virtual Billing: A346 can be billed as A346A for services rendered through video, but not by telephone. Comply with the Comprehensive Virtual Care Services criteria from Appendix J.
4What Your Clinical Note Must Show
Ensure the following documentation is in order:
- Maintain a copy of the new written request for the repeat consultation in the medical record.
- Verify and document that interval care was provided by another physician before the repeat consultation.
- For virtual consultations billed as A346A, ensure compliance with video service requirements.
5Weak vs. Strong Note Examples
The strong note succeeds due to specific, documented evidence of interval care by another physician and the inclusion of the new written referral, fulfilling A346's billing requirements. The weak note lacks necessary details such as interval care and the referral source.
Patient returned for follow-up. Symptoms persist. Will reassess treatment options.
Patient referred again for recurrence of symptoms post-initial treatment.
Interval care provided by Dr. Smith during patient's recent hospitalization. New referral from Dr. J. Doe received.
- Referral document scanned and attached.
- Video consult conducted according to Comprehensive Virtual Care standards.
