1What Is the A895 OHIP Code?
What is A895?
A895 represents a consultation conducted by psychiatrists during a special visit to a hospital. This service is typically used when a psychiatrist is called outside of regular hours to assess a patient in urgent psychiatric situations. These situations often involve acute suicide risk assessments, determination of involuntary patient capacity, or evaluations of first-episode psychosis that demands immediate decision-making.
It is crucial to note that this code implies a special trip to the hospital, differentiating it from regular consultations or those conducted during scheduled visits. A common oversight is the necessity of claiming the special visit premium separately from the consultation, with specific prefixes based on the patient's location: 'C' for hospital inpatients, 'W' for long-term care, and 'K' for emergency department visits.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A190 | Special psychiatric consultation | Billed as per psychiatric consultation needs for complex cases. | A specialized consultation involving extensive psychiatric evaluation. |
| A195 | Consultation | Billed as needed for initial psychiatric evaluations. | General consultation in the psychiatric listings. |
| A196 | Repeat consultation | Billed for subsequent consultations as required. | Consultation for follow-up assessments. |
| A395 | Limited consultation | Billed for shorter assessment consultations. | Short duration consultations for limited assessments. |
3Eligibility Requirements
Eligibility Criteria for A895
To bill for A895, the following criteria must be met:
- Frequency: A895 can be billed for a single patient, by the same physician, for the same diagnosis once every two consecutive 12-month periods. An exception exists for two services within two years if the second service is for a hospital inpatient or emergency department patient more than 12 but less than 24 months after the first.
- Unrelated Diagnoses: For clearly defined unrelated diagnoses, A895 can be billed once every 12 months.
- Billing Codes: In association, the special visit premium must be separately billed with the correct prefix based on the hospital setting: 'C' for in-patients, 'W' for long-term care, or 'K' for emergency departments.
- Neurodevelopmental Conditions: Consultations for less complex conditions, such as ADHD in children or adolescents, might be subject to a lesser fee.
4What Your Clinical Note Must Show
When billing for A895, ensure the following documentation is clearly recorded:
- Detailed patient history and presenting complaint.
- Duration of direct contact with the patient, confirming a minimum of 75 minutes.
- Conclusive diagnosis and management plan.
- Justification for immediate psychiatric assessment, including risk assessments conducted.
5Weak vs. Strong Note Examples
The strong note succeeds by providing specific details on the patient's condition, duration of consultation, risk assessments, and justification for intervention, while the weak note lacks depth and specificity.
Patient seen for psychiatric evaluation in emergency department. Discussed symptoms and made management plan.
Patient presented with acute suicidal ideation. Conducted comprehensive psychiatric evaluation and suicide risk assessment lasting 80 minutes. Determined immediate need for involuntary admission based on current mental state and history. Developed and initiated a crisis management plan.
- Detailed symptoms and risk factors reviewed.
- Documented discussion time exceeding minimum requirements.
- Clear rationale for immediate intervention outlined.
