1What Is the A645 OHIP Code?
What is the A645 OHIP Billing Code?
The A645 billing code is designated for consultation services in the specialty of thoracic surgery. It is typically used for initial surgical consultations where a specialist is asked to evaluate a patient with complexities like lung nodules, esophageal tumors, or pleural processes. In such cases, the thoracic surgeon provides an expert opinion on the feasibility and advisability of surgical intervention.
This code is often missed due to misunderstanding of eligibility requirements or failure to properly document the consultation request. Ensuring all documentation is in order is crucial to billing this service correctly.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | No more than two consultations per patient, per 12 months | Used for detailed, complex surgical consultations in thoracic surgery. |
| C935 | Special surgical consultation | No more than two consultations per patient, per 12 months | Applicable when the consultation service is performed on a hospital inpatient. |
| A646 | Repeat consultation | Defined frequency according to specific circumstances | Billed when a follow-up consultation is necessary. |
| C645 | Consultation | As per A645 conditions, but for hospital in-patient setting | The inpatient equivalent of A645. |
3Eligibility Requirements
Eligibility Requirements for A645
- Written Request: A consultation must be requested by a referring physician, nurse practitioner, or dental surgeon in writing.
- Referral Documentation: The written request must identify the consultant by name or specialty, detail the referring practitioner’s information (including name and billing number), and provide patient identification.
- Referral Reason: The request must specify the complexity or obscurity of the case, or the necessity for a second opinion.
- Frequency Limits: The A645 code can be billed once per two consecutive 12-month periods for the same diagnosis. However, if a second consultation with the same diagnosis is required for a patient in a hospital or Emergency Department, it can be billed a second time if rendered more than 12 months but less than 24 months after the first. Additional consultations for unrelated diagnoses can be billed once every 12 months.
4What Your Clinical Note Must Show
To ensure full payment for a consultation, the following requirements must be met:
- A written request signed by the referring physician, nurse practitioner, or dental surgeon.
- The request must include the consultant's name and/or specialty, the referring practitioner's name and billing number, and patient identification.
- The request should outline the medical necessity, including case complexity or any specific questions needing the consultant's opinion.
- A written report summarizing findings and recommendations must be sent to the referring party.
For virtual consultations, additional documentation is required:
- Patient consent for virtual consultation recorded in the patient's chart.
- A detailed note of the consultation start and end times.
5Weak vs. Strong Note Examples
The strong note succeeds because it provides a comprehensive overview of the consultation, including detailed findings, impressions, and actions. The weak note fails due to lack of specifics and documentation of the consultation's purpose or outcome.
Consulted patient regarding lung mass. Outcome: pending further tests. Will follow up.
Patient referred by Dr. Smith for evaluation of lung nodule. Consultation dictated addressing resectability and surgical fitness. Reviewed patient's imaging and history, confirming operability. Drafted and sent detailed report to Dr. Smith with recommendations for potential surgery.
- Detailed reasons for consultation.
- Summary of findings and impressions.
- Outline of plan and recommendations.
- Confirmation of report sent to referring physician.
