1What Is the A925 OHIP Code?
What is A925?
The A925 OHIP billing code is designated for a limited consultation in the field of Occupational Medicine. This type of consultation is performed when a specialist is requested to offer their expert opinion on a narrowly focused question, common in workplace health assessments, such as evaluating a specific exposure to determine the cause of a symptom or assessing a worker's fitness for a particular task. Such consultations typically require less time than comprehensive evaluations.
Limited consultations play a vital role in occupational health by enabling physicians to provide targeted assessments that address specific questions without the necessity of a full consultation. This efficiency helps both the physician and the system manage patient care more effectively.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A720 | Comprehensive occupational medicine consultation | Subject to standard consultation frequency limits | Used for in-depth consultations in occupational health. |
| A725 | Consultation | Subject to standard consultation frequency limits | Standard consultation covering broader assessments. |
| A726 | Repeat consultation | As necessary for follow-up on the same diagnosis | Used for a follow-up or repeated consultations as required. |
| C720 | Comprehensive occupational medicine consultation | Subject to standard consultation frequency limits | Similar to A720 but used for hospital in-patients. |
3Eligibility Requirements
Eligibility Requirements
To qualify for billing under A925, several conditions must be met:
- Referral Requirement: The consultation must be requested in writing by a physician, nurse practitioner, or dental surgeon in connection with an insured dental procedure performed in a hospital. The referrer should have professional knowledge of the patient.
- Consultation Context: The consultation should follow due to the complexity, seriousness, or obscurity of the case, or if another opinion is specifically requested by the patient or their representative.
- Frequency: A925 is limited to one service per two consecutive 12-month periods for the same patient, physician, and diagnosis. A separate service is allowable once every 12 months for an unrelated diagnosis.
Note: Services rendered via telephone are not eligible for A925 billing when conducted virtually. Only video consultations qualify under the Comprehensive Virtual Care Services.
4What Your Clinical Note Must Show
Ensure the request for consultation is appropriately documented.
- Written request from a physician, nurse practitioner, or dental surgeon.
- Include the complexity, seriousness, or specificity of the case as identified by the referrer.
5Weak vs. Strong Note Examples
The strong note succeeds because it provides a comprehensive account of the referral, patient symptoms, and specific assessment goals. The weak note lacks detail and context, which are essential for billing justification.
Patient referred by GP. Evaluate exposure to chemicals. Signed Dr. Smith.
Patient referred by Dr. Taylor, GP, for evaluation of potential chemical exposure due to recent workplace incidents. The patient reports symptoms of headache and rash post exposure. Consultation required for fit to return to work assessment for the task of operating machinery.
- Referral details from Dr. Taylor.
- Specific issue related to chemical exposure.
- Notes on symptoms: headache, rash.
- Assessment purpose: determine fit for machinery operation.
