1What Is the A474 OHIP Code?
What is A474?
A474 is a billing code in the Ontario Health Insurance Plan (OHIP) specifically for medical specific re-assessments rendered by specialists in respirology. This code is typically used in out-patient settings, allowing respirologists to evaluate the efficacy of treatment plans by performing a full history and physical examination of the patient.
Respirology re-assessments might focus on conditions such as asthma or COPD, especially if there have been recent changes to medication or therapy, like an inhaler adjustment or modification of oxygen delivery settings.
This billing code provides a structured means to ensure thorough patient follow-ups and continuity of care, preventing lapses in treatment efficacy post-intervention.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A473 | Medical specific assessment | Initial assessment | Initial evaluation of respiratory conditions, typically involves comprehensive history and examination. |
| C473 | Medical specific assessment | Initial hospital-based assessment | First assessment for hospital in-patients with respiratory issues. |
| A471 | Complex medical specific re-assessment | As clinically required | Re-assessment involving detailed evaluation of complex patients. |
| C471 | Complex medical specific re-assessment | As clinically required (in-patient) | Complex re-evaluation for hospital in-patient care. |
3Eligibility Requirements
Eligibility Requirements for A474
A474 can be billed by respirologists who perform a specific re-assessment that includes a comprehensive history and examination relevant to the patient's respiratory condition. The service can be rendered and billed for up to two times per patient per physician within a consecutive 12-month period, except when re-assessments are performed upon hospital admissions.
When recording the service, it is mandatory to note the start and end times of the assessment in the patient's medical record to validate the service duration. A474 can also be delivered virtually, using the billing designation A474A, in accordance with Appendix J guidelines for video or telephone consultations.
4What Your Clinical Note Must Show
Ensure the following details are recorded:
- Full and relevant history with physical examination details.
- Specific start and end times of the service.
- Details of any treatment modifications or patient response evaluations.
5Weak vs. Strong Note Examples
The strong note succeeds by providing comprehensive clinical details and documentation of service duration, supporting thorough medical evaluation while clearly justifying the billable service.
Patient assessed. COPD follow-up. Updated inhaler prescription.
Conducted detailed respiratory examination for COPD management.
Reviewed patient's medication history, noting adherence to new inhaler regimen.
Patient reports improvement in dyspnea with current inhaler. Consider advocating for additional pulmonary function test.
- Start time: 10:05 AM
- End time: 10:30 AM
