1What Is the A665 OHIP Code?
The A665 code is utilized for prenatal consultations performed by pediatricians. These consultations usually occur when specific neonatal risks are anticipated, such as antenatal diagnosis of congenital anomalies, expected preterm births, prior children with genetic conditions, or maternal health issues likely to affect newborn health.
Billing the A665 code allows pediatricians to engage with expectant parents to develop a detailed care plan and set expectations before the child's birth.
The code may be underutilized if the consultation is not documented as specifically prenatal or if there is a misunderstanding about whether the criteria for the consultation have been met before the baby is born.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A260 | Special paediatric consultation | Varies | A higher complexity paediatric consultation, typically involving complex cases. |
| A265 | Consultation | Varies | Regular pediatric consultations. |
| A266 | Repeat consultation | Varies | Repeated instances of pediatric consultations, |
| A565 | Limited consultation | Varies | Simplified or brief pediatric consultations for specific cases. |
3Eligibility Requirements
A665 can be billed to OHIP by pediatricians performing prenatal consultations. Key eligibility details include:
- Billing Frequency: The code can be billed once per two consecutive 12-month periods per patient and physician, same diagnosis. An exception allows a second billable service within the same period if it occurs more than 12 but less than 24 months after the first and is for a hospital inpatient or emergency department visit.
- Virtual Delivery: This consultation can be rendered virtually as a video-only service (billed as A665A). Telephone consultations do not qualify.
For further clarity, refer to the OHIP Schedule of Benefits.
4What Your Clinical Note Must Show
Documentation should clearly indicate the prenatal nature of consultation, including details such as:
- Antenatally diagnosed conditions
- Risk factors such as expected preterm birth
- Plan for the newborn's care
- Family preparation and discussion outcomes
5Weak vs. Strong Note Examples
The strong note provides a clear, thorough record of the consultation's purpose and the specific topics discussed, which align with A665 billing requirements. The weak note lacks specificity and does not demonstrate the prenatal focus necessary for A665.
The patient discussed general preparatory topics with the pediatrician.
A detailed consultation was conducted with the expectant parents focusing on the following key areas:
- Reviewed antenatally diagnosed cardiac anomaly.
- Discussed potential hospitalization needs post-birth.
- Prepared family on monitoring needs and medical interventions required.
- Outlined follow-up plan involving detailed assessments post-delivery.
