1What Is the A355 OHIP Code?
What is A355?
The A355 code is used for billing consultations performed by urologists under the Ontario Health Insurance Plan (OHIP). This service involves a detailed evaluation of complex patient cases such as haematuria, elevated PSA, obstructive symptoms, or scrotal masses. A355 provides the framework for a comprehensive assessment, which includes collaborating with a referring physician, nurse practitioner, or dental surgeon.
Often missed due to documentation oversights, it's essential to ensure that all referral and consultation documentation is correctly completed and maintained. The complex nature of cases within urology highlights the importance of these consultations, contributing valuable insights for patient management.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | As needed | Higher fee for complex surgical consultations within urology. |
| C935 | Special surgical consultation | As needed | Applies to inpatient settings, higher fee for complex consultations. |
| A356 | Repeat consultation | As needed | Used for follow-up consultations, lower fee than initial consultation. |
| C355 | Consultation | As needed | Billed for inpatient consultations in a hospital setting. |
3Eligibility Requirements
Eligibility Requirements
To bill the A355 code, a consultation must meet specific criteria:
- Request: The consultation must follow a written request from a referring physician, nurse practitioner, or dental surgeon. This request must be based on the complexity or seriousness of the patient's condition, requiring the specialized opinion of a urologist.
- Consultation Report: A comprehensive consultation report, including findings, opinions, and recommendations, must be prepared and sent to the referring provider.
- Documentation: Maintain a copy of the written referral request in your medical records, except when common records are used, in settings like hospitals or multi-specialty clinics.
- Frequency Limits: Typically, one A355 service per patient, per physician, per diagnosis, over two consecutive 12-month periods, with exceptions for hospital inpatients and emergency care.
- Virtual Services: A355 can be billed as A355A if the service is rendered via video, not telephone.
Failure to meet these requirements will result in the service being paid at a lesser assessment fee.
4What Your Clinical Note Must Show
Ensure thorough record-keeping to avoid reduced fees.
- Retain a copy of the signed referral request in the patient's record.
- Include complete identification of the consultant and referring party.
- Document the time and duration of the service provided.
5Weak vs. Strong Note Examples
The strong note includes detailed referral information, assessment duration, and comprehensive findings with follow-up actions, while the weak note lacks specificity and detail.
Patient referred for consultation. Assessment performed.
Received referral from Dr. Smith, MD, billing #123456, for patient John Doe, OHIP#456789, regarding elevated PSA.
Comprehensive assessment conducted for 45 minutes. Findings indicate potential need for further imaging. Written report sent to Dr. Smith with recommendations.
- Clearly identified referring physician and purpose of referral.
- Specific findings and recommendations noted.
