1What Is the A476 OHIP Code?
A476 represents a repeat consultation service in the discipline of respirology under OHIP in Ontario. This code is utilized when a patient previously assessed by a respirologist is re-evaluated for the same respiratory condition after interim management by another physician.
In a respirology context, a typical scenario might involve a patient with COPD or interstitial lung disease who experiences an exacerbation. The initial exacerbation was managed by the patient's family physician, leading to a new referral back to the respirologist for further specialty management.
Physicians commonly miss billing with A476 due to misunderstanding the requirement for a new referral, particularly in cases where continuous management blurs the distinction between initial and repeat consultations.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A470 | Comprehensive respiratory disease consultation | Limited to context specific uses. | Extensive evaluation for complex respiratory diseases. |
| A475 | Consultation | Subject to consultation frequency limits. | Standard respirology consultation for initial evaluations. |
| A575 | Limited consultation | Available without frequency restrictions but context-dependent. | Brief assessment typically pertaining to less complex cases. |
| C470 | Comprehensive respiratory disease consultation in hospital | Structured for in-patient hospital settings. | In-depth consultation for hospitalized respiratory cases. |
3Eligibility Requirements
Eligibility Requirements:
- Referral Requirement: A repeat consultation must be accompanied by a new written request from a referring physician, nurse practitioner, or dental surgeon.
- Documentation: Maintain a copy of the referral within the medical record unless occurring in facilities with common medical records.
- Service Context: Can be rendered virtually via video, but not by telephone.
Failure to meet these requirements leads to billing adjustments to a lesser fee, typically a general assessment fee.
4What Your Clinical Note Must Show
Every repeat consultation requires documentation of a written request.
- The request must be signed by the referring professional.
- A copy should be maintained in the medical record.
- Exceptions apply in multi-specialty or common record facilities.
Ensure compliance with virtual care eligibility.
- Limited to video consultations only.
- Ensure documentation includes evidence of video service delivery.
5Weak vs. Strong Note Examples
The strong note clearly documents the reason for repeat evaluation, includes the new referral, and identifies the specific context in which the service was delivered.
Patient seen today for repeat evaluation. Handled exacerbation since last visit.
Reviewed patient's COPD condition after exacerbation managed by Dr. Smith. New referral noted in chart, detailed discussion on current management options and potential adjustments made.
- Signed referral from Dr. Smith filed on 2023-10-01.
- Video consultation conducted on telehealth platform, documented video session.
