1What Is the A460 OHIP Code?
The A460 billing code in Ontario covers a comprehensive infectious disease consultation. This service is provided by infectious disease specialists and involves a detailed evaluation of complex cases, typically requiring a minimum of 75 minutes of direct patient interaction.
These consultations are commonly sought for cases such as prolonged fever of unknown origin or patients undergoing long-term suppressive therapy with multiple drug interactions.
A comprehensive consultation addresses the complexity, seriousness, or obscurity of the case, distinguishing it from limited consultations that are less time-intensive and comprehensive.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A275 | Limited consultation | Variable | Covers limited consultations within the Infectious Disease listings. |
| A465 | Consultation | Variable | Standard consultation for infectious disease cases, less comprehensive than A460. |
| A466 | Repeat consultation | Variable | For repeat consultations under infectious disease listings. |
| C275 | Limited consultation (Hospital In-Patient) | Variable | Limited consultation applicable to hospital in-patients. |
3Eligibility Requirements
To be eligible for billing under the A460 code, the consultant must satisfy the following criteria:
- The consultation must follow a written request from a qualified referring provider, such as a physician, nurse practitioner, or dental surgeon in the context of a related hospital-based procedure.
- A minimum of 75 minutes of direct patient contact is required, excluding any other billable service time.
- The consultation must include all necessary elements and conclude with a written report containing findings, opinions, and recommendations.
- Medical records must reflect precise start and end times for the consultation.
- Frequency limits apply: one service per two consecutive 12-month periods for the same patient and diagnosis. An exception allows a second consultation if performed in a hospital or ER 12-24 months after the first.
4What Your Clinical Note Must Show
Accurate start and stop times are mandatory.
- Ensure the recorded times are documented on the patient's permanent medical record.
A written request from a referring entity is essential.
- Must include identification of the consulting physician and the referring entity by name and billing number.
- The request should detail the service needed and the patient's pertinent information.
A comprehensive report is required post-consultation.
- Include findings, opinions, and recommendations based on the consultation.
- Submit the report to the referring entity.
5Weak vs. Strong Note Examples
The strong note includes specific start and stop times, a clear summary of the consultation, and comprehensive documentation of outcomes and recommendations. The weak note fails to provide specific details and does not document consultation times accurately.
Consultation completed. Duration around 75 minutes. Discussed the main health concerns.
Comprehensive infectious disease consultation conducted.
Start Time: 10:15 AM
End Time: 11:30 AM
Discussed differential diagnosis of prolonged fever and reviewed patient's current suppressive therapy, noting interactions. Detailed recommendations sent to Dr. Smith, the referring physician.
- Recorded precise times with the consultation duration.
- Documented discussion points and outcomes clearly.
