1What Is the A815 OHIP Code?
Definition and Clinical Context
A815 is an OHIP billing code used for assessments performed at the request of a midwife or Aboriginal midwife in an outpatient setting. This code is specifically for scenarios where a midwife identifies a situation beyond their practice scope, such as managing hypertension during pregnancy or addressing newborn jaundice, and seeks a physician's expertise for a comprehensive assessment.
Commonly Overlooked Details
Due to its specificity, A815 is distinct from general consultation codes. It's important for physicians and their billing staff to remember that this code covers assessments, not consultations. Failure to recognize this distinction often leads to missed billing opportunities.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A914 | GP focused practice comprehensive consultation by Video | Family Practice & Practice In General (00) listings | $247.40 charge for GP comprehensive consultation via video. |
| A006 | Repeat consultation | Family Practice & Practice In General (00) listings | $47.10 for a repeat consultation in family practice. |
| A010 | GP focused practice consultation by Video | Family Practice & Practice In General (00) listings | $95.60 for GP consultation via video. |
| A011 | GP focused practice repeat consultation by Video | Family Practice & Practice In General (00) listings | $47.10 charge for repeated GP consultation by video. |
3Eligibility Requirements
Eligibility Requirements
The A815 billing code is applicable only when a midwife or Aboriginal midwife formally requests a special assessment for an obstetrical or newborn patient. It applies in office or outpatient settings, separate from in-patient services, for which the corresponding code is C815. Adherence to the General Preamble assessment rules is essential for correct billing.
4What Your Clinical Note Must Show
Ensure documentation includes the following elements:
- Formal request from a midwife or Aboriginal midwife.
- Comprehensive assessment details outlining the identified issue.
- Physician's written opinion and recommendations.
5Weak vs. Strong Note Examples
The strong note provides a comprehensive, detailed, and structured account of the assessment, fulfilling documentation requirements, unlike the brief and vague weak note.
Patient seen at midwife's request. Assessed for hypertension. Follow-up advised.
A detailed assessment conducted upon the midwife's request for pregnancy-related hypertension. Comprehensive review of patient's medical history, physical examination, and lab results. Recommendations include medication adjustment and dietary changes. Follow-up scheduled.
- Inclusion of all assessment details and findings.
- Clear documentation of the midwife's request.
- A well-defined treatment and follow-up plan.
