1What Is the A735 OHIP Code?
A735 is the OHIP billing code used for Diagnostic Consultations in Nuclear Medicine. This involves a nuclear medicine specialist providing a detailed written opinion based on nuclear medicine studies referred from a different institution or facility. The typical scenarios include assessing complex diagnostic problems such as interpreting a difficult thyroid uptake or bone study.
Physicians often miss billing opportunities for this code due to misunderstanding the eligibility criteria, such as the condition requiring a written opinion rather than a standard report, or failing to recognize the permissible frequency limitations.
As a specialist service, A735 is rendered only when the consultation is specifically requested by another healthcare professional and involves a comprehensive review of imaging and laboratory data to aid in patient management.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A635 | Consultation | as required | Used when the intensity or complexity justifies a higher fee. |
| A636 | Repeat consultation | as required | A follow-up consultation within an existing case. |
| A835 | Comprehensive nuclear medicine consultation | as required | For very complex or comprehensive consultations. |
| C635 | Consultation | as required | Consultation for a hospital in-patient. |
3Eligibility Requirements
The A735 billing code is eligible for billing by nuclear medicine specialists under specific circumstances:
- The consultation must involve a written request from a referring physician, nurse practitioner, or dental surgeon.
- The specialist must provide a written report back to the referring professional including findings, opinions, and recommendations.
- Consultations are limited to one service per two consecutive 12-month periods for the same patient and diagnosis, except under specific conditions where a second consultation within the period may be allowed.
- When the diagnosis is unrelated, one service is allowed every 12 months.
- Virtual delivery is permissible via video, not telephone.
- A consultation is not payable if the service was requested post-service delivery or if the comparison studies are from different institutions.
4What Your Clinical Note Must Show
For a valid A735 billing, retain all relevant documentation as follows:
- A written request from a referring professional, which must be kept on record.
- A thorough written report back to the referrer, including all findings and recommendations.
- Record time of consultation service start and end on the patient's medical record.
5Weak vs. Strong Note Examples
The strong note succeeds due to its specificity and completeness, documenting both consultation details and adherence to billing requirements, unlike the weak note, which lacks detail.
Consulted on the thyroid scan. Report completed.
Comprehensive diagnostic evaluation conducted at the request of Dr. Smith regarding patient’s abnormal thyroid uptake scan. Written report with diagnostic impressions and further investigation recommendations sent back to Dr. Smith.
- Time started: 14:00, Time ended: 14:30
- Referral request filed in patient's record
