1What Is the A912 OHIP Code?
The A912 billing code applies to comprehensive family and general practice consultations, specifically designed for situations where a physician provides an in-depth, 75-minute consultation to address complex medical and social issues. This typically involves patients with multiple chronic conditions, extensive medication management, and requires significant family involvement in planning and follow-up care.
This code is critical for physicians managing medically and socially complicated patients. It allows physicians to dedicate sufficient time for assessing and planning comprehensive care for patients who require ongoing, extensive management due to the intricacy of their health conditions.
Physicians might overlook this code when unaware of the time-related requirements or if the complexity of the case is not well-documented. Ensuring detailed and accurate documentation can help capture the reimbursement deserved for such intensive consultations.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A914 | GP focused practice comprehensive consultation by Video | One service per two consecutive 12-month periods | Used for comprehensive consultations conducted via video. |
| A005 | Consultation | Allowed frequency varies | For general consultations that do not meet the 75-minute criteria. |
| A006 | Repeat consultation | Allowed frequency varies | For follow-up consultations after an initial consultation is billed. |
| A010 | GP focused practice consultation by Video | Allowed frequency varies | For video consultations of less complexity than A914. |
3Eligibility Requirements
To be eligible for billing under code A912:
- The consultation must include a minimum of 75 minutes of direct patient contact, exclusive of any time spent on other billable interventions.
- A written request from a referring physician, nurse practitioner, or dental surgeon must have been received and kept in the medical record unless the consultation occurs in a setting with shared medical records.
- The consultation must result in a written report back to the referring party, detailing findings, opinion, and recommendations.
- Consultations under this code are limited to one service per two consecutive 12-month periods for the same diagnosis, unless specific conditions are met for additional consultations.
Make sure to record the start and stop times in the patient's medical record as failure to do so will result in payment adjusted to a lesser paying fee.
4What Your Clinical Note Must Show
Record the duration the physician spent with the patient for the consultation directly in the patient's permanent medical record.
- Include exact start time.
- Include exact stop time.
Maintain a copy of the written request for consultation from the referring party.
- The request must include the name and billing number of the referrer.
- Identify the patient's name and health number.
- Specify the services required.
Prepare and send a detailed report back to the referring practitioner.
- Include the consultant’s findings.
- Detail opinions and recommendations.
5Weak vs. Strong Note Examples
The strong note provides detailed time tracking and specific clinical actions taken, supporting the complexity and duration required for billing A912. In contrast, the weak note lacks specific details and time documentation.
Patient seen for various medical issues. Sessions covered multiple conditions and future plan discussed.
Consultation initiated at 10:00 AM and concluded at 11:30 AM to address complex patient management.
Patient presented with Type 2 Diabetes, hypertension, and cognitive concerns.
- Reviewed current medications and adjusted dosages.
- Comprehensive care plan discussed and documented.
