1What Is the A365 OHIP Code?
The A365 billing code pertains to a special interventional radiological consultation. This service involves complex, obscure, or serious problems requiring significant expertise. The attending radiologist must spend a minimum of 50 minutes in direct patient contact, which excludes any separately billable procedures or non-patient-facing activities like chart review or documentation.
Clinically, this consultation is typically employed before intricate interventional procedures such as embolization or difficult biopsies. Due to the complexity and time requirement, it is essential for radiologists to document time accurately.
This procedure might be missed due to improper documentation of time or an unclear distinction from less complex consultations.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A335 | Consultation | Once per 12 months for the same diagnosis unless otherwise specified. | Standard consultation for less complex cases. |
| C335 | Consultation | Once per 12 months for the same diagnosis unless otherwise specified. | Standard consultation services provided in a hospital. |
| C365 | Special interventional radiological consultation | Same limits as A365 but specific to hospital inpatients. | Equivalent of A365 for inpatient settings. |
| A331 | Minor assessment | As required for brief assessments. | Used for brief and less detailed assessments. |
3Eligibility Requirements
To be eligible to bill A365 under OHIP, several criteria must be met:
- Complexity and Duration: The consultation must involve a problem of a very complex, obscure, or serious nature, requiring at least 50 minutes of direct patient contact.
- Referral Requirements: A written consultation request must be made by a referring physician, nurse practitioner, or dental surgeon familiar with the patient.
- Documentation: The request must be retained in the patient’s medical record, specify the consulting physician, and include relevant patient and provider details.
- Frequency: A365 is billable once per two consecutive 12-month periods for the same diagnosis, with exceptions for consultations taking place in hospital inpatient or emergency settings where at least 12 but not more than 24 months have passed since the last consultation. For unrelated diagnoses, one service is billable every 12 months.
4What Your Clinical Note Must Show
Ensure that the written consultation request is properly documented.
- A copy of the written request signed by the referring physician.
- Identification of the consulting physician and specialty.
- Specific information regarding the service required for the consultation.
Record the start and end times of the consultation directly in the patient's chart.
- Ensure that the time spent meets the minimum 50-minute requirement.
- Exclude any time spent on other billable services or non-patient-facing activities.
5Weak vs. Strong Note Examples
The strong note is effective due to precise time documentation and detailed reference to the degree of complexity and referral source, whereas the weak note lacks necessary specificity.
Patient seen for consultation regarding interventional radiology procedure. Duration noted but not specific; referral source not mentioned.
Consultation on 10/10/23 for embolization procedure. Referred by Dr. Smith, due to complex vascular issue. Consultation lasted 50 minutes, from 2:00 PM to 2:50 PM.
- Specific referral details.
- Exact consultation start and end times.
- Clear statement of the complex nature of the case.
