1What Is the A835 OHIP Code?
What is the A835 Service?
The A835 billing code applies to a comprehensive consultation conducted by a nuclear medicine specialist. This service involves providing an extensive evaluation, necessary when standard nuclear consultations don't suffice due to complex medical scenarios. Clinicians spend a minimum of 75 minutes in direct contact with the patient, ensuring a detailed, patient-centric approach that discusses therapy indications, dosimetry, and follow-up needs.
Such consultations are usually warranted before or after therapeutic radionuclide treatments where careful consideration of diagnosis, treatment viability, and patient education is essential. These consults prevent mismanagement by allowing sufficient time for patient and family discussions, improving treatment outcomes.
Since A835 consultations require direct patient contact and a comprehensive approach, they are easily missed if documentation is incomplete or if the provider fails to match the necessary time requirement.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A635 | Consultation | Once per 12 months | Basic consultation code in nuclear medicine. |
| A636 | Repeat consultation | Once if criteria for repeat are met | Follow-up consultation for continued management. |
| A735 | Diagnostic consultation | When required by diagnostic procedure criteria | Consultation for diagnostic opinions between facilities. |
| C635 | Consultation | Once per 12 months | In-patient consultation code in nuclear medicine. |
3Eligibility Requirements
Eligibility Requirements for A835
- Consultation Time: The physician must spend a minimum of 75 minutes in direct contact with the patient.
- Medical Record Documentation: Start and stop times of the consultation must be documented in the patient's permanent medical record.
- Frequency Limits: A maximum of one A835 service per two consecutive 12-month periods is allowed for the same patient, same physician, and same diagnosis. However, if the second service is provided in a hospital setting or Emergency Department between 12 to 24 months after the first, two services may be billed in the same period.
- Unrelated Diagnosis: Services related to a clearly different diagnosis may be billed once every 12 months.
- Virtual Delivery: Consultations may be billed virtually as A835A, but only as a video service, not by telephone.
4What Your Clinical Note Must Show
Ensure accurate documentation for A835 includes the following:
- Service start and end times in the patient's records.
- A written referral request from a qualified practitioner.
- Comprehensive notes detailing the consultation process.
5Weak vs. Strong Note Examples
The strong note succeeds by clearly documenting the start and stop times, providing detailed context on the consultation, and including all necessary referral and procedural details. The weak note fails due to lack of timing and detail.
Patient consulted for nuclear medicine options. Time spent not recorded.
Conducted a comprehensive nuclear medicine consultation regarding therapeutic radionuclide treatment.
- Consultation began at 10:15 am and ended at 11:45 am.
- Discussed full treatment options and dosimetry.
- Referring physician: Dr. Smith, ID: ABC123.
- Patient interactions thoroughly documented with findings and recommendations.
