1What Is the A655 OHIP Code?
A limited consultation under OHIP’s A655 billing code is an assessment provided by a hematologist that addresses a focused clinical question. This service typically requires less time than a full consultation and may involve tasks such as interpreting a single abnormal lab index or determining the need for further investigation, such as a bone marrow examination.
This code is most commonly used in office or outpatient clinic settings where the complexity or obscurity of a case is less demanding than would warrant a full consultation. Due to its targeted nature, the A655 simplifies the process for physicians dealing with isolated or specific diagnostic queries.
Commonly missed because of misunderstandings about the criteria for limited consultations, it is essential for practitioners to ensure that all consultation components, such as a documented referral and distinct diagnosis, are satisfied.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A615 | A615 Consultation | Unlimited, subject to conditions | $192.90 for a full consultation under the hematology category. |
| A616 | A616 Repeat Consultation | As needed, subject to referral | $118.05 for a repeat consultation under the hematology category. |
| C615 | C615 Consultation | Unlimited, subject to conditions | $192.90 for a hospital in-patient full consultation. |
| C616 | C616 Repeat Consultation | As needed, subject to referral | $118.05 for a hospital in-patient repeat consultation. |
3Eligibility Requirements
The A655 code can be billed when a hematologist conducts a limited consultation following a written request from a referring physician, nurse practitioner, or dental surgeon for an insured dental procedure. It can also be delivered virtually via video, billed as A655A, but is not eligible for billing through telephone consultations.
Consultations are subject to frequency limits: one service per two consecutive 12-month periods for the same patient, physician, and diagnosis. Another service may be billed if for a clearly defined unrelated diagnosis, but only once every 12 months. For hospital in-patients, the code C655 may be used.
4What Your Clinical Note Must Show
Ensure the following documentation is present in the patient's medical record:
- A written referral from a physician, nurse practitioner, or dental surgeon.
- Evidence of a focused consultation based on the presenting question.
- Detailed notes outlining the consultation's findings and recommendations.
- Video-only delivery method if billed as A655A.
5Weak vs. Strong Note Examples
The strong note succeeds with clear context, comprehensive evaluation details, and follow-up actions, demonstrating more substantial consultation efforts compared to the weak note.
Patient seen for abnormal CBC. Discussed results.
Consultation at the request of Dr. Smith to evaluate abnormal CBC.
Reviewed patient's medical history and current CBC levels.
Determined that no immediate marrow examination is needed; advised follow-up testing in two months.
- Complete next steps: Follow-up CBC test in two months.
- Referral details included.
