1What Is the A745 OHIP Code?
A745 represents a limited consultation service in radiation oncology. This service is designed for focused evaluations that are less demanding and typically require less time than a full consultation. An example includes addressing a singular question such as whether a single painful bone metastasis warrants palliative radiotherapy.
Limited consultations are crucial for efficiently handling specific concerns without the need for extensive interaction. They ensure that patient care is expedited, providing answers to immediate and particular questions. Physicians should note that due to its restricted nature, A745 may be overlooked, as more comprehensive evaluations often seem automatically more appropriate in complex cases.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A345 | Consultation | Limited to one service per two consecutive 12-month periods | Full consultation involving detailed evaluation. |
| A346 | Repeat consultation | As needed following revisits for the same diagnosis | Repeat assessment after the initial consultation. |
| C345 | Consultation | Limited to one service per two consecutive 12-month periods | Hospital inpatient consultation equivalent. |
| C346 | Repeat consultation | As needed following revisits for the same diagnosis | Repeat assessment in hospital after initial consultation. |
3Eligibility Requirements
For billing code A745 to be eligible, the following conditions must be satisfied:
- Virtual delivery: Only video consultations are eligible under A745 as comprehensive virtual care services. Telephone services do not qualify.
- Referral requirements: A consultation should arise from a written request by a referring physician, nurse practitioner, or dental surgeon related to an insured dental procedure in a hospital setting. This request is warranted due to the complexity, seriousness, or obscurity of the clinical case.
Billing Limitations:
- Consultations for the same patient and diagnosis by the same physician are limited to one service per two consecutive 12-month periods, unless it's a repeat consultation or under specific conditions such as hospital inpatient settings.
- Limited consultation requires criteria alignment with GP16 and GP19 from OHIP's Schedule of Benefits.
4What Your Clinical Note Must Show
Ensure documentation includes written request from a referring practitioner due to complexity or urgency.
- Request by a physician, nurse practitioner, or dental surgeon.
- Reference to specific medical necessity or obscurity of the case.
Record details of the consultation, including the primary question or focus area addressed during the session.
- Outline the specific issue discussed, such as treatment necessity for bone metastasis.
- Include duration and nature ('limited scope') of consultation.
Summarize the findings or opinions offered during the consultation and any recommendations provided.
- Recommendations, such as opting for palliative radiotherapy if applicable.
- Document any follow-up actions or next steps advised.
5Weak vs. Strong Note Examples
The strong note is successful because it includes specific referral details, a clear focus of assessment, and documented recommendations. The weak note lacks these essential elements and is too generic.
Patient seen for consultation. Discussed pain management options.
Patient referred by Dr. Smith to evaluate whether palliative radiotherapy is appropriate for single bone metastasis causing severe pain.
Conducted limited consultation focusing solely on this issue. Determined that radiotherapy is advisable.
- Referral attached confirming complexity of case.
- Specific assessment findings documented.
- Recommendations clearly communicated to patient.
