1What Is the A475 OHIP Code?
What is A475?
The A475 billing code represents a consultation service provided primarily by respirologists in Ontario. This service is typically used after a referral for cases such as chronic cough, abnormal chest imaging, suspected asthma, COPD, or sleep-disordered breathing assessment.
Such consultations require a detailed review of the patient's condition followed by a comprehensive report provided back to the referring physician, nurse practitioner, or dental surgeon.
It's important to note that failure to adhere to documentation and eligibility criteria can result in denied claims, leading to unnecessary follow-up and administration costs.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A470 | Comprehensive respiratory disease consultation | One service per patient per year | Used for more extensive consultations involving detailed case evaluation. |
| A476 | Repeat consultation | Subject to limits depending on diagnosis status | Used when ongoing follow-up for the same condition is necessary. |
| A575 | Limited consultation | One service per patient per year | For less complex consultations not requiring full comprehensive service. |
| C470 | Comprehensive respiratory disease consultation | One service per patient per year | Hospital-based comprehensive consultation. |
3Eligibility Requirements
Eligibility Requirements for A475
To bill under the A475 code, the following conditions must be met:
- Referral Requirement: A written request for a consultation must be received from a referring physician, nurse practitioner, or dental surgeon for a related insured dental procedure.
- Documentation: The written request must identify the patient by their name and health number, the referring party by name and billing number, and specify the service required.
- Report Submission: A detailed written report from the consulting physician to the referrer is necessary.
- Service Frequency: This code can be billed once every two consecutive 12-month periods per patient per diagnosis, with specific exceptions allowing a second consultation in cases where the second is for a hospital inpatient or emergency department patient.
Please ensure all documentation is retained in the patient’s medical records, particularly if the consultation occurs outside of a common medical record setting.
4What Your Clinical Note Must Show
Ensure all necessary details are recorded accurately.
- Referral request must be written and signed by the referring healthcare provider.
- Include all relevant client information such as health number, referrer details, and specific services requested.
- Written consultation report shared with the referrer promptly.
5Weak vs. Strong Note Examples
The strong note succeeds by providing clear clinical details and follow-up actions, while the weak note fails to offer sufficient information or next steps.
Patient seen for chronic cough. Awaiting further instructions from GP.
Consultation completed at GP's request for chronic cough evaluation. Findings suggest mild asthma. Further testing recommended. Full report sent to referring GP.
- Date and time of consultation
- Patient's detailed medical history
- Assessment findings
- Recommendations
