A400 OHIP Billing Code: Comprehensive Community Medicine Consultation Details

The A400 billing code under OHIP refers to a Comprehensive Community Medicine Consultation. It is primarily utilized by specialists in community medicine to conduct extensive public health assessments of individual patients. Typical consultation scenarios include follow-up for communicable diseases, planning for immunizations, and addressing occupational and environmental exposure issues.

These consultations necessitate a significant commitment of time, with the specialist spending a minimum of 75 minutes in direct contact with the patient. This extended duration is pivotal for a thorough evaluation, addressing complex or serious presentations that surpass standard consultations.

A400 engagements are often missed due to the stringent documentation and time requirements, as well as the necessity for a formal written referral from a physician, nurse practitioner, or dental surgeon.

To be eligible for billing under A400, the following conditions must be met:

1. The consultation requires a written request from a referring physician, nurse practitioner, or dental surgeon.
2. The consulting physician must spend at least 75 minutes in direct patient contact.
3. Start and stop times of the consultation must be accurately recorded in the patient's permanent medical record.
4. A400 can be billed once per patient, per physician, and per diagnosis in two consecutive 12-month periods. If a second service is required, it must be for an inpatient or emergency patient and occur more than 12 but less than 24 months after the initial consultation.

For unrelated diagnoses, one service is eligible every 12 months.

Virtual consultations are permissible only via video, billed as A400A. Telephone consultations are not eligible under this code.