1What Is the A695 OHIP Code?
The A695 code is used by psychiatrists to bill for neurodevelopmental consultations involving complex adult presentations. These consultations are typically comprehensive assessments addressing conditions such as suspected autism spectrum disorder in adults, complex ADHD with psychiatric comorbidity, and intellectual disabilities with psychiatric manifestations.
Common scenarios include addressing complex cases where psychiatric and organic causes of behavioral decompensation coexist, or evaluating genetic conditions with known neuropsychiatric phenotypes. It is critical to note that consultations for children, adolescents, or less complex conditions like standard ADHD are billed at a lower fee, per the OHIP Schedule of Benefits.
Physicians often overlook the code's specificity for complex adult cases, mistaking it for broader applicability which the Schedule explicitly does not support. Non-patient-facing activities, such as reviewing documentation or conducting other billable procedures during consultation, should not be included in the calculated time for this billing code.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A190 | Special psychiatric consultation | As outlined in schedule | Requires a minimum of 75 minutes in direct patient contact. |
| A195 | Consultation | As outlined in schedule | Comprehensive consultation services in psychiatry. |
| A196 | Repeat consultation | As outlined in schedule | Consultations following an initial assessment. |
| A395 | Limited consultation | As outlined in schedule | Offers a condensed version of psychiatric consultation. |
3Eligibility Requirements
To bill for A695, the neurodevelopmental consultation must meet specific criteria:
- Frequency: Same physician, same patient, same diagnosis: one service per two consecutive 12-month periods. An exception allows for a second service within the same two consecutive 12-month period if it occurs more than 12 but less than 24 months after the initial consultation and is performed in a hospital inpatient or emergency department setting.
- Diagnosis: A different, unrelated diagnosis allows billing once every 12 months.
- Virtual Care: Services delivered virtually must be conducted via video and billed as A695A. Virtual consultations via phone are not eligible.
- Time Calculation: Does not include time spent on other billable services, or non-patient-facing tasks like reviewing documentation.
4What Your Clinical Note Must Show
Ensure comprehensive documentation of the consultation to support billing A695. Include:
- Patient history and presenting symptoms
- Details of the psychiatric assessment and diagnosis
- Differential diagnosis process, if applicable
- Treatment recommendations and patient care plan
- Duration of the consultation and patient interactions
- Justification for complex case designation
5Weak vs. Strong Note Examples
The strong note succeeds because it provides a detailed account of the patient's condition and the comprehensive assessment performed, supporting the complexity required for A695. The weak note fails to capture this depth.
Patient presented with ADHD. Discussed treatment options over a short visit.
Patient presented with complex ADHD and concurrent mood disorder. Conducted a comprehensive assessment over 90 minutes. Explored genetic syndrome possibilities.
Developed a thorough management plan addressing psychiatric and environmental factors.
- Highlighted patient's psychiatric history and referral details.
- Documented detailed differential diagnostic process.
- Outlined a multidisciplinary approach to patient management.
