1What Is the A935 OHIP Code?
The A935 billing code refers to a 'Special Surgical Consultation' in the field of general surgery. This code is specifically for consultations that require a minimum of 50 minutes of direct patient contact. Typical clinical scenarios in which a general surgeon might use A935 include complex abdominal wall reconstructions following multiple prior surgeries, discussions surrounding inflammatory bowel disease with potential stoma implications, cases of suspected malignancy requiring detailed staging discussions, and re-operative hepatobiliary procedures with challenging anatomy.
This code is commonly missed in cases where the consultation might be lengthy, but the required 50-minute minimum contact with the patient is not documented as per the specifications. Surgeons may also underutilize A935 when the complexity of the case necessitates in-depth discussion beyond standard consultations, particularly in the context of preoperative planning where multidisciplinary approaches are essential. Accurate time documentation is necessary to validate the service rendered under A935.
2Related Codes
3Eligibility Requirements
To bill A935, the consultation must be initiated by a written request from a referring physician, nurse practitioner, or dental surgeon. The request must clearly state the need for a special surgical opinion due to complexity, seriousness, or obscurity of the patient's condition. The consulting surgeon must provide a report back to the referring clinician.
A935 requires at least 50 minutes of direct patient interaction, separate from any other billable intervention. The physician must record start and end times of the patient interaction in the medical record for claim eligibility.
A935 may be billed once per two consecutive 12-month periods for the same diagnosis unless a second consultation is rendered in a hospital setting 12 to 24 months after the first. Consultations for unrelated diagnoses are eligible once every 12 months, provided documentation supports the distinctness of each consultation. For services that exceed these limits or lack necessary documentation, only a general or specific assessment rate is payable. Furthermore, A935 can be rendered virtually using video consultation as A935A. Telephone consultations are not eligible under this billing code.
4What Your Clinical Note Must Show
The following elements are required for billing A935:
- Request from a referring physician, nurse practitioner, or dental surgeon with their name, signature, and billing number.
- Clear description of the consulting need due to case complexity or obscurity.
- Patient's name and health number documented along with the start and end times of the consultation.
- A written report provided back to the referring healthcare provider.
5Weak vs. Strong Note Examples
Patient seen for 50 minutes, discussed procedure options. End.
