1What Is the A446 OHIP Code?
What is A446?
A446 is a billing code under the Ontario Health Insurance Plan (OHIP) used for repeat consultations in medical oncology. This code is specifically applicable when an oncologist is requested to see a patient again for the same malignancy after the initial consultation.
These follow-up consultations often occur when the patient's condition has changed, such as disease progression on first-line therapy, a new imaging result altering the staging, or when the systemic therapy plan needs revisiting at the request of the referring physician. The consultation is billed per encounter once a new written request is received.
It is important to note that each repeat consultation requires a new written referral. Failing to secure this documentation will result in the service being adjusted to a general or specific assessment, leading to potential under-reimbursement.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A445 | Consultation | As needed with new written request | Used for initial consultations in medical oncology. |
| A845 | Limited consultation | As needed with limitations | Applies to limited consultations in medical oncology. |
| C445 | Consultation | As needed in hospital settings | For consultations in hospital in-patient settings. |
| C446 | Repeat consultation | As needed in hospital settings | The hospital in-patient equivalent of A446. |
3Eligibility Requirements
Eligibility Requirements for A446
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Virtual Delivery: A446 can be conducted via video and billed as A446A. Telephone consultations are not eligible and cannot be billed under this code.
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Written Request: A new written request from a referring physician, nurse practitioner, or dental surgeon is mandatory for each repeat consultation.
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Hospital In-Patient: For services rendered to hospitalized patients, the equivalent code is C446.
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Fee and Frequency: A446 is billed at a flat fee of CAD 115.95 and is exempt from the consultation frequency limits outlined in GP17.
4What Your Clinical Note Must Show
Ensure the following documents are secured and maintained for billing A446:
- A new written request from the referring physician, nurse practitioner, or dental surgeon.
- Detailed records of the consultation, highlighting the reasons for the repeated visit.
- Notes on changes in the patient's condition, treatment plans, or any new decisions made.
5Weak vs. Strong Note Examples
The strong note succeeds by providing specific details on the patient's condition and treatment changes, while the weak note lacks necessary detail and context.
Follow-up consultation for previously diagnosed cancer. Discussed new treatment options.
Patient revisited due to progression of malignancy after first-line therapy. Reviewed new imaging findings that indicate a change in staging from II to III. Reassessed systemic therapy plan with patient and discussed options, including chemotherapy adjustments.
- Included specific changes in the patient's cancer stage.
- Detailed the revised systemic therapy plan and patient agreement.
- Noted the reasoning behind treatment changes based on new medical evidence.
