1What Is the A667 OHIP Code?
In pediatrics, the A667 billing code represents a comprehensive neurodevelopmental consultation, which is crucial for diagnosing various developmental disorders in children. This high-value consultation is priced at $456.80, reflecting its complexity and the depth of assessment required. Typically, cases warranting A667 include suspected autism spectrum disorder, global developmental delays, and school-age learning difficulties such as intellectual disabilities. The consultation requires gathering multi-informant histories and performing standardized assessments.
A notable aspect often missed with A667 is the strict limitation of one billing per patient per physician per 12-month cycle, compared to more frequent allowances under other consultation codes. Additionally, compliance with documentation mandates, such as recording the start and stop times, is essential to avoid a reduced fee.
For a consultation delivered virtually, it's critical to note that A667 can only be billed as A667A via video, as telephone consultations do not qualify under this billing code.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A260 | Special paediatric consultation | As per the Paediatrics listing payment rules | A more general pediatric consultation, priced at $342.25. |
| A265 | Consultation | As per the Paediatrics listing payment rules | A standard consultation within pediatrics, at $190.35. |
| A266 | Repeat consultation | As per the Paediatrics listing payment rules | Follow-up consultation within pediatrics, billed at $104.70. |
| A565 | Limited consultation | As per the Paediatrics listing payment rules | A brief consultation within pediatrics, at $104.70. |
3Eligibility Requirements
To be eligible for billing the A667 code, the service must meet the following conditions:
- It is limited to one consultation per patient, per physician, within a 12-month period.
- Start and stop times of the consultation must be accurately recorded in the patient's permanent medical record; failure to do so results in a reduced payment.
- For virtual delivery, the service must be rendered via video; telephone consultations are ineligible under this code.
4What Your Clinical Note Must Show
Ensure these are correctly included in the patient’s permanent medical record:
- Accurate start and stop times of the consultation.
5Weak vs. Strong Note Examples
The strong note provides a thorough account of the consultation process, including detailed clinical actions and the required start/stop times, ensuring compliance with billing requirements. The weak note lacks specificity and essential documentation.
Consultation for neurodevelopmental assessment. Follow-up needed.
Neurodevelopmental consultation conducted for suspected autism spectrum disorder. Detailed developmental history collected from parents and school. Standardized assessments completed. Diagnosis and management plan discussed.
- Start Time: 9:00 AM
- Stop Time: 11:00 AM
