1What Is the A913 OHIP Code?
What is A913?
A913 is an OHIP billing code for GP focused practice special consultations conducted via video. This code allows physicians designated in focused practices, such as addiction medicine or chronic pain, to conduct comprehensive consultations that are longer and more involved than standard video consultations.
Despite the ease of virtual communication, it's important to remember that this code is specific to physicians with a formal designation in a focused practice area. Instances of missed billing typically occur due to overlooking this eligibility requirement, as the complexity of the consultation alone does not qualify an undesignated physician to use this billing code.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A914 | GP focused practice comprehensive consultation by Video | Frequent as needed | For comprehensive virtual consultations by designated GP focused practice physicians. |
| A006 | Repeat consultation | As needed | For repeat consultations without complexity warranting special codes. |
| A010 | GP focused practice consultation by Video | Frequent as needed | Standard consultation via video for GP focused practices. |
| A011 | GP focused practice repeat consultation by Video | As needed | Repeat consultations by video for GP focused practices. |
3Eligibility Requirements
Eligibility for A913
- Designated Physicians Only: Only those designated by the MOH-OMA GP Focused Practice Review Committee or eligible for the focused practice psychotherapy premium may bill this code.
- Consultation Specifics: Valid for special consultations conducted via video.
- Frequency: Billable once per two consecutive 12-month periods per patient, per diagnosis, unless specific conditions allow for additional billing.
- Exclusions: A913 cannot be billed for consultations conducted by telephone as it falls under VIDEO ONLY eligibility.
4What Your Clinical Note Must Show
Ensure documentation captures the following for billing A913:
- Physician's focused practice designation status.
- Nature and details of the consultation conducted by video.
- Rationale for special consultation distinction compared to standard consultations.
- Patient's diagnosis and any changes from previous consultations.
5Weak vs. Strong Note Examples
The strong note succeeds by clearly documenting the physician's designation, the complexity of the consultation, and specific action plans, while the weak note lacks detail and justification for billing A913.
Conducted a video consultation with patient for chronic pain management. Discussed treatment options.
Conducted a comprehensive video consultation for chronic pain management under focused practice designation. Discussed new treatment regimen due to the patient's non-response to previous therapies and adjusted medication plan accordingly. Patient education provided on potential side effects and follow-up plan established.
- Confirmation of focused practice designation.
- Clear documentation of consultation complexity and necessity.
- Details of treatment adjustments and educational components.
