1What Is the A636 OHIP Code?
A636 is an OHIP billing code used for repeat consultations in Nuclear Medicine. This code applies when a patient returns for further evaluation of the same issue by the same consultant after care has been provided by another physician. The clinical context often involves patients with conditions like thyroid disease or potential bone lesions who require additional assessment after imaging or treatment changes.
Due to the need for a new written request for each repeat consultation, this code is frequently overlooked. Ensuring thorough documentation per the specific requirements is essential to properly billing for these consultations.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A635 | Consultation | Limited to one per 2 consecutive 12-month periods except under special circumstances | Initial consultation for Nuclear Medicine listed under code 63. |
| A735 | Diagnostic consultation | As applicable | Consultation focused on diagnostic interpretation within Nuclear Medicine. |
| A835 | Comprehensive nuclear medicine consultation | As applicable | Detailed consultation services that encompass comprehensive evaluation in Nuclear Medicine. |
| C635 | Consultation | As applicable | Same service as A635 but for hospital in-patient settings. |
| C636 | Hospital in-patient repeat consultation | Dependent on the same conditions as A636 | Repeat consultation service rendered to an in-patient setting |
3Eligibility Requirements
To be eligible for billing code A636, certain criteria must be met:
- Written Request: A new written request signed by the referring physician, nurse practitioner, or dental surgeon must be maintained in the consultant's medical record, unless the consultation occurs in a hospital, long-term care institution, or multi-specialty clinic with common records.
- Virtual Service: The service can be delivered virtually via video and billed as A636A. Telephone consultations are not eligible.
Failing to adhere to these requirements may result in a reduced payment equivalent to a lesser assessment fee.
4What Your Clinical Note Must Show
Maintain a copy of the signed written request from the referring party in the patient's medical record.
- Signed by referring physician, nurse practitioner, or dental surgeon
- Located within the consulting physician's records, not required if in shared facility records
Ensure that A636 consultations occur either in-person or via eligible virtual options.
- Video consultations are eligible
- Telephone consultations are ineligible
5Weak vs. Strong Note Examples
The strong note succeeds by clearly documenting the timing, context, and presence of the new written referral, which are critical for fulfilling A636 documentation requirements.
Patient seen on 01/10/2023 for repeat consult regarding same clinical issue.
Referral noted but not attached.
Patient seen on 01/10/2023 for a repeat consultation regarding thyroid evaluation.
Referred back by Dr. Smith following interim treatment.
Attached is the written referral request.
- Detailed description of the clinical issue
- Evidence of interim care by another physician
- New written referral attached
