1What Is the A801 OHIP Code?
What is A801?
A801 represents a comprehensive genetic assessment requested by a midwife or aboriginal midwife due to complex, obscure, or serious patient concerns. When billed appropriately, this code reflects a thorough evaluation process that requires a geneticist to spend at least 75 minutes in direct consultation with the patient.
This service typically involves cases where a midwifery client shows a positive carrier screen or there is a notable family history necessitating a detailed three-generation pedigree analysis. This thorough process assists in making informed decisions regarding diagnostic testing.
It's crucial to ensure that the consultation and evaluation are comprehensive, as incomplete information may lead to this service being overlooked or not billed properly.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A220 | Special genetic consultation | As per other applicable rules | An assessment service provided by a geneticist with a less restrictive criteria compared to A801. |
| A223 | Extended special genetic consultation | As per other applicable rules | A more involved genetic consultation requiring greater expertise and time. |
| A225 | Consultation | As per other applicable rules | Standard consultation service within genetics. |
| A226 | Repeat consultation | As per other applicable rules | Follow-up consultations after an initial assessment. |
3Eligibility Requirements
Eligibility for Billing A801
- Written Request: The genetic assessment must be explicitly requested in writing by a midwife or an aboriginal midwife.
- Duration Requirement: A minimum of 75 minutes of direct contact with the patient is required, excluding any time spent on separate billable interventions.
- Frequency: A801 is limited to one per patient, per physician, per 24-month period.
- Reporting: Findings, opinions, and recommendations must be provided in writing to both the midwife or aboriginal midwife and, if applicable, the patient's primary care physician or nurse practitioner. Failure to comply will result in reduced payment.
- Medical Record Keeping: Start and stop times must be recorded in the patient's permanent medical record. Retaining the written request in the patient's record is mandatory to avoid fee reduction.
- Virtual Service: When conducted virtually, A801 is billed as A801A and should occur via video only, not telephone.
4What Your Clinical Note Must Show
Follow these guidelines to ensure compliance and eligibility for billing:
- Record start and stop times in the patient's permanent medical record.
- Include the written request from the midwife or aboriginal midwife in the patient’s medical record.
- Document the genetic assessment findings and share with the requesting midwife and the patient's primary care provider if relevant.
5Weak vs. Strong Note Examples
The strong note is successful due to its detailed account of the assessment, precise time documentation, and confirmation of communication with relevant parties. The weak note lacks this specificity, potentially jeopardizing reimbursement.
Patient was seen for genetic assessment. Discussed family history and concerns.
Comprehensive genetic assessment conducted thorough family history review. Confirmed positive carrier status and provided recommendations.
Start Time: 09:00, End Time: 10:45.
All documentation and recommendations have been forwarded to the requesting midwife and primary care provider.
- Accurate recording of times
- Details on assessment findings and actions
- Confirmation of forwarded results
