1What Is the A646 OHIP Code?
A repeat consultation under the A646 code is intended for thoracic surgeons needing to reassess a patient for the same problem after care from another physician. Typical examples include follow-ups on a pulmonary nodule, or when a patient's lung function status changes. This process ensures continuous monitoring and decision-making for conditions initially deemed non-operative.
These consultations are vital for patients with evolving clinical needs that may now meet surgical thresholds. They allow surgeons to provide specialized updates on treatment plans, ensuring patient safety and optimized care outcomes. Nevertheless, it's crucial to ensure all billing requirements are met to avoid downgrading to a lesser assessment fee.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | No frequency limits, determined per case requirements | This code is for specific, complex surgical consultations in thoracic surgery, carrying a higher fee. |
| C935 | Special surgical consultation | No frequency limits, determined per case requirements | Hospital inpatient equivalent to A935 for complex surgical consultations. |
| A645 | Consultation | Limited to one consultation per two consecutive 12-month periods unless certain conditions apply | General consultation service in thoracic surgery settings. |
| C645 | Consultation | Limited to one consultation per two consecutive 12-month periods unless certain conditions apply | Hospital inpatient equivalent to A645 for general consultations. |
3Eligibility Requirements
To be eligible for billing the A646 code:
- A new written request, signed by the referring physician, nurse practitioner, or dental surgeon, is mandatory, and must be retained in your records unless the consultation is in a setting with common medical records like a hospital or multi-specialty clinic.
- These consultations arise from a reassessment of the same issue after interim care provided by another physician.
- The A646 code can be billed without frequency limits as long as these conditions are met, separating it from initial consultations limited by frequency rules.
- Note that for virtual services, it can only be billed if performed by video, as telephone consultations are not eligible.
4What Your Clinical Note Must Show
Maintain the following in patients' medical records for each repeat consultation:
- New written request from referring physician, nurse practitioner, or dental surgeon.
- Reason for repeat consultation, evidencing interval care by another physician.
- Records of video-based service if billed as A646A.
5Weak vs. Strong Note Examples
The strong note succeeds by detailing patient history, interim care, and updated clinical findings, whereas the weak note lacks specificity and fails to capture the necessity of the repeat consultation.
Patient seen for repeat consultation. Discussed situation.
Patient presents for repeat consultation on the previously noted pulmonary nodule.
Interval care by Dr. Smith in cardiology; recent CT scan shows size increase.
- Reviewed CT scan results and changes in patient’s condition.
- Discussed updated surgical options given improved lung function.
