1What Is the A626 OHIP Code?
The A626 billing code is used for repeat consultations within the specialty of clinical immunology and allergy. This code allows specialists to see a patient for a second time regarding the same medical issue, provided there is a new written request from a referring physician, nurse practitioner, or dental surgeon.
In practice, this may involve patients whose initial treatment plans for conditions such as asthma or chronic urticaria have proven ineffective, or where adjustments to an immunotherapy regimen are necessary due to reactions. These repeat consultations are crucial for amending patient management plans based on new developments or treatment responses.
Common reasons for missing this billing opportunity include not obtaining a new written request or mistakenly believing repeat consultations are subject to frequency restrictions. Ensuring proper documentation of these elements is key to appropriate billing.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A525 | Limited consultation | N/A | Used for brief consultations in clinical immunology. |
| A625 | Consultation | N/A | Standard full consultation in clinical immunology, allowing a thorough patient review. |
| C525 | Limited consultation | N/A | Limited consultation fee for hospital in-patients. |
| C625 | Consultation | N/A | Consultation fee for comprehensive evaluations for hospital in-patients. |
3Eligibility Requirements
A626 may be billed under the OHIP system when the service involves a repeat consultation at the request of a referral from a physician, nurse practitioner, or dental surgeon. Importantly, a new written referral is required for each occurrence. This code can be used without adhering to consultation frequency limits outlined in GP17. However, if payment requirements aren't met, payments may be adjusted to those for a general or specific assessment.
Virtual consultations are eligible to be billed under this code, specifically for video-based interactions, and should be billed as A626A. Note that telephone consultations are not included as eligible Comprehensive Virtual Care Services. For hospital in-patient services, C626 is the equivalent billing code.
4What Your Clinical Note Must Show
A new written request is necessary for each repeat consultation.
- Referring physician, nurse practitioner, or dental surgeon must provide a new request.
- Ensure documentation is attached to the patient's file.
Eligibility for virtual billing of A626.
- Must be conducted via video call.
- Telephone consultations do not qualify.
5Weak vs. Strong Note Examples
The strong note is successful because it includes specific reasons for the repeat consultation, a reference to the new written request, and detailed clinical evaluations. The weak note fails as it lacks documentation of a new referral and detailed patient assessments.
Patient revisited for asthma management.
Consultation conducted based on previous request.
Patient revisited due to unsuccessful initial management of chronic urticaria.
New referral received from Dr. Smith.
Discussed new management approaches; evaluated reaction to previous treatment.
- Attached new written referral from Dr. Smith.
- Detailed evaluation of treatment response.
