1What Is the A911 OHIP Code?
A911 is a billing code under OHIP for special family and general practice consultations involving at least 50 minutes of direct patient contact. This is typically used in situations where a patient has multiple interacting chronic conditions or requires a complex goals-of-care discussion that a standard consultation cannot adequately cover.
Such consultations are necessary when the standard assessment tools are insufficient for addressing patient needs. For instance, if a patient with chronic diabetes, hypertension, and mental health issues presents needing a coordinated care plan, A911 allows physicians to conduct an in-depth assessment.
Because of the time requirement and the necessity to record start and stop times accurately, this code can often be overlooked or improperly used. Ensuring compliance with all documentation requirements is crucial for successful billing.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A914 | GP focused practice comprehensive consultation by Video | Varies based on circumstance | For comprehensive consultations conducted via video, generally involving similar criteria for complexity as A911. |
| A005 | Consultation | Once per 12 months for related diagnosis | General family practice consultations without the extended time requirement. |
| A006 | Repeat consultation | As required | Used for follow-up consultations not subject to the same complexity level as A911. |
| A010 | GP focused practice consultation by Video | Once per 12 months for related diagnosis | Video consultations with complexity similar to A005 but delivered via telehealth. |
3Eligibility Requirements
To be eligible for billing under the A911 code, the consultation must meet specific criteria:
- The consultation must be rendered following a written request from a referring physician, nurse practitioner, or dental surgeon, who requests the opinion of a physician due to the complexity, seriousness, or obscurity of the case.
- At least 50 minutes of direct contact time with the patient is required, excluding time spent on other separately billable interventions.
- Start and stop times must be documented in the patient's permanent medical record.
- A written report, including findings and recommendations, must be prepared for the referring practitioner.
In cases where a consultation for the same diagnosis has already been provided, it can only be billed once per two consecutive 12-month periods unless certain conditions are met, such as hospital inpatient scenarios.
4What Your Clinical Note Must Show
Ensuring complete documentation is critical to successfully billing A911 under OHIP.
- Include a written request from the referring practitioner indicating the need for the consultation.
- Document start and stop times for the consultation in the patient's permanent medical record.
- Prepare a detailed report with findings, opinions, and recommendations for the referring practitioner.
5Weak vs. Strong Note Examples
The strong note succeeds due to its detailed chronological and referral documentation, fulfilling all A911 billing requirements, whereas the weak note lacks specificity and necessary timing details.
Patient seen for chronic condition management. Advised on lifestyle changes.
No start/stop times or referral details documented.
Consultation requested by Dr. Smith (Ref. #123456).
Spent 55 minutes in direct contact discussing diabetes, hypertension, and mental health management.
Start: 10:00 AM, Stop: 10:55 AM.
Detailed report sent to Dr. Smith with recommendations for follow-up.
- Accurate recording of consultation start and stop times.
- Comprehensive summary of patient interaction and issues addressed.
