1What Is the A385 OHIP Code?
What is the A385 Billing Code?
The A385 billing code is designated for limited neurology consultations within the Ontario Health Insurance Plan (OHIP). This code applies to consultations focusing on a specific issue or question, such as interpreting an abnormal nerve conduction study, determining if an anticonvulsant can be discontinued, or offering a brief opinion on a medication-induced tremor. A385 is the shortest consultation in the neurology listing, making it a practical choice for straightforward, focused queries.
A385 is often misapplied in cases necessitating comprehensive assessments. If a broader neurological assessment is required, code A185, which is tailored for more extensive consultations, should be billed instead. Additionally, the in-patient equivalent of this code is C385, relevant when delivering care within a hospital setting.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A180 | Special neurology consultation | As clinically necessary considering OHIP limits | Used for more comprehensive assessments requiring detailed evaluations. |
| A185 | Consultation | Once per two consecutive 12-month periods for the same diagnosis | Employed for full neurological assessments. |
| A186 | Repeat consultation | Same restrictions as A385 | For subsequent follow-ups on previous consultations. |
| A682 | Extended special neurology consultation | As clinically necessary with documented complexity | Reserved for complex cases requiring extensive work-up. |
3Eligibility Requirements
Eligibility for A385 Billing
A385 can be claimed for limited neurology consultations provided the service is delivered via video as per Appendix J, Section 1, but not via telephone. It is crucial to ensure services rendered align with OHIP rules regarding consultation frequency:
- Frequency Limits: One A385 service can be billed per two consecutive 12-month periods when the consultation regards the same patient, physician, and diagnosis. For consultations concerning unrelated diagnoses, A385 can be billed once every 12 months.
- In-Patient Equivalent: Use C385 for in-patient consultations reflecting the same service.
Ensure documentation supports the virtual service delivery requirements and frequency regulations to prevent disputes.
4What Your Clinical Note Must Show
Record meticulous details during the neurology consultation to substantiate the particular focus and resolution of the consult.
- Patient history and relevance to the specific neurology concern.
- Objective findings specific to the diagnosis question.
- Clinical advice or recommendations provided.
- A clear indication of why a limited consultation was appropriate.
- Compliance with OHIP's virtual care video-only delivery requirement, if applicable.
5Weak vs. Strong Note Examples
The strong note details the specific focus of the consultation, includes relevant patient history, provides actionable advice, and documents the mode of consultation delivery. The weak note lacks specifics and fails to demonstrate the consultation's purpose or method.
Patient seen for neurology consult. Discussed medication.
Patient referred for evaluation of recent abnormal nerve conduction study.
Reviewed patient's medical history, specifically recent developments related to peripheral neuropathy.
Confirmed current findings align with prior results; advised potential discontinuation of current anticonvulsant pending follow-up testing.
Consultation occurred via permissible video format, meeting virtual care criteria.
- Specific history related to consultation query
- Documented video consultation delivery
- Comprehensive advice commensurate with limited focus
