1What Is the A800 OHIP Code?
What is the A800 Billing Code?
A800 is an OHIP billing code used for genetic assessments requested by midwives or Aboriginal midwives in Ontario. This service is specifically designed to handle complex, obscure, or serious patient issues that require a geneticist's expertise. Common scenarios include abnormal prenatal screenings or a family history of inherited conditions. While the request can only come from a midwife, the geneticist is responsible for both the assessment and providing a written report to the midwife and any relevant primary care provider. Failure to include the report may lead to a reduced fee.
Why Is This Code Commonly Missed?
The A800 can be overlooked if the request from the midwife is not properly documented or if the report is not shared with all required parties. Additionally, misunderstandings about the appropriate scenarios for the billing, such as complications in pregnancy or a suspected genetic disorder, may result in missed billing opportunities.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A220 | Special genetic consultation | As per Genetics listing | Consultation for special genetic needs requiring the expertise of a geneticist. |
| A223 | Extended special genetic consultation | As per Genetics listing | Extended consultation for particularly complex genetic cases. |
| A225 | Consultation | As per Genetics listing | General consultation under the Genetics specialty. |
| A226 | Repeat consultation | As per Genetics listing | Repeat of a genetic consultation, as necessary. |
3Eligibility Requirements
A800 Eligibility Requirements
- Who requests it: the assessment must be requested in writing by a midwife or Aboriginal midwife. An urgent or emergency request may be initiated verbally but must subsequently be requested in writing.
- Why: the request must be because of the complex, obscure or serious nature of the patient's problem.
- What the service includes: the common and specific elements of an assessment. The Schedule sets no minimum duration for A800. The 75-minute and 90-minute requirements belong to the comprehensive (A801) and extended (A802) tiers, which are separate codes at higher fees.
- Frequency: one per patient, per physician, per 24 month period.
- Written report: the geneticist must submit findings, opinions and recommendations in writing to both the midwife or Aboriginal midwife and the patient's primary care physician or nurse practitioner, if applicable, or the amount payable is reduced to a lesser fee.
- Medical record: the written request from the midwife must be retained on the patient's permanent medical record, or the amount payable is reduced to a lesser fee. Start and stop times are not required for A800 - that requirement applies to A801.
4What Your Clinical Note Must Show
Two documents decide whether A800 is paid in full:
- The midwife's or Aboriginal midwife's written request, retained on the patient's permanent medical record.
- The written report of findings, opinions and recommendations, sent to both the midwife and the patient's primary care physician or nurse practitioner, if applicable.
- No start-and-stop-time entry is required for A800; that requirement belongs to A801.
5Weak vs. Strong Note Examples
The strong note provides a detailed account of the service, including the time spent, reason for assessment, and distribution of findings, ensuring compliance with billing requirements.
Genetic assessment conducted for patient. Request came in by phone.
Nothing records the written request or the report back, and those are the two things payment turns on.
Genetic assessment at the written request of midwife J. Smith (request filed on the permanent record), for a family history of an inherited condition raised at the booking visit.
History, examination and risk discussion completed; written findings and recommendations sent to the midwife and to the patient's family physician the same day.
- Written request from the midwife retained on the permanent medical record.
- Report of findings, opinions and recommendations sent to both the midwife and the primary care physician.
- No A800 billed for this patient by this physician in the preceding 24 months.
- Duration not asserted - A800 carries no minimum time; had the encounter run to 75 minutes, A801 would have been the code.
