1What Is the A945 OHIP Code?
A special palliative care consultation under the A945 billing code is specifically designed for cases where patients require intensive palliative management. This typically includes situations such as advanced cancer or end-stage organ failure where comprehensive symptom management and detailed care planning are critical.
Physicians must spend a minimum of 50 minutes in direct contact with the patient and/or their family. The focus is on assessing and meeting the patient's psychosocial needs, reviewing pharmacotherapy, and coordinating appropriate community and home care services.
The complexity of these consultations often leads to them being missed or underutilized. Ensuring that all eligibility criteria and documentation are meticulously followed can aid in correct billing and better patient care.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A914 | GP focused practice comprehensive consultation by Video | Variable | Used for comprehensive consultations by video. |
| A005 | Consultation | Variable | Basic consultation service for initial patient assessment. |
| A006 | Repeat consultation | Variable | Used for follow-up consultations with the same condition. |
| A010 | GP focused practice consultation by Video | Variable | Used for focused consultations provided via video. |
3Eligibility Requirements
To bill A945, certain criteria must be met:
- The consultation must result from a written request from a referring physician, nurse practitioner, or dental surgeon.
- At least 50 minutes of direct consultation time must be recorded, focusing primarily on the patient.
- Start and stop times must be documented in the medical record.
- Psychosocial assessment, a comprehensive review of pharmacotherapy, and appropriate counseling must be provided.
- Documentation must include the consultation request and a report to the referring provider.
- Virtual consultations are allowed but must be conducted via video and billed as A945A.
4What Your Clinical Note Must Show
Ensure a formal written request from the referring provider is included in the patient's file.
- Request should specify the service and include relevant details about the patient.
Accurate documentation of consultation time is mandatory.
- Record both start and stop times clearly in the patient's permanent record.
Create a comprehensive report following the consultation.
- Report should include findings, recommendations, and forward to the referring provider.
5Weak vs. Strong Note Examples
The strong note clearly includes the required start and stop times, details about the consultation, and a comprehensive follow-up report, fulfilling all documentation requirements.
Consultation completed for Mr. Smith. Discussed patient care.
Special palliative care consultation for Mr. Smith.
Total duration: 55 minutes. Discussed pain management, medication review, and available home support services.
- Start time: 10:00 AM
- Stop time: 10:55 AM
- Report sent to Dr. Brown.
