1What Is the A464 OHIP Code?
The A464 billing code pertains to medical specific re-assessment services provided by infectious disease specialists under OHIP. This service involves a thorough re-evaluation focused on previously assessed medical problems. Particularly prevalent in cases such as patients undergoing prolonged intravenous antimicrobial therapy for conditions like endocarditis or osteomyelitis, the re-assessment ensures these patients maintain a positive response and tolerance to their prescribed regimen.
A specific re-assessment is crucial in confirming therapy effectiveness and modifying treatment plans if necessary. By frequently evaluating the patient’s progress and adjusting treatments, specialists can better manage these chronic conditions.
This code can be easily overlooked due to its specific focus on re-assessing ongoing treatment rather than initial assessments or routine follow-ups. Physicians must remember its utility in managing long-term treatment plans.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A463 | Medical specific assessment | $107.00 | Initial specific assessment for infectious diseases. |
| C463 | Medical specific assessment | $107.00 | Part of a comprehensive care plan for in-patients. |
| W464 | General re-assessment of patient in nursing home | $20.60 | Assessment in a nursing home under the Nursing Homes Act. |
| A461 | Complex medical specific re-assessment | $95.05 | Complex re-assessment requiring all elements of a specific assessment. |
3Eligibility Requirements
To bill A464 under OHIP, the following eligibility criteria must be met:
- The re-assessment must be performed by a specialist in infectious diseases and should include a complete and relevant history and physical examination of one or more systems.
- Specific and medical specific re-assessments are limited to two per patient per physician per consecutive 12-month period, with exceptions for re-assessments related to hospital admissions.
- The start and stop times of the re-assessment must be documented in the patient's permanent medical record. Failure to do so will result in the fee being adjusted to a lesser paying rate.
- The code can be billed for virtual consultations as A464A.
4What Your Clinical Note Must Show
Ensure accurate records are maintained for billing A464.
- Record the start and stop times of the service in the patient's permanent medical record.
Provide comprehensive documentation of the re-assessment.
- Include a full and relevant history of the problem.
- Conduct and document a physical examination of one or more systems.
5Weak vs. Strong Note Examples
The strong note succeeds by clearly documenting critical procedural details and times, whereas the weak note fails to provide evidence of the assessment period and lacks specificity.
Patient seen for follow-up without detailed time tracking.
Patient re-evaluated for ongoing IV antibiotic treatment, start time 10:00 AM, end time 10:30 AM.
Comprehensive assessment done, examining cardiovascular and musculoskeletal systems.
- Start and stop times documented
- Specific systems evaluated
- Patient response to current therapy documented
