A220 – Special genetic consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Special genetic consultation is a consultation in which the physician provides all the elements of a consultation (A225) and spends a minimum of 75 minutes in direct contact with the patient with or without family, exclusive of time spent rendering any other separately billable intervention to the patient.
When to Use
- Bill A220 when a patient requires a detailed discussion of complex hereditary cancer syndromes, including risk assessment and management options, lasting at least 75 minutes.
- Use A220 for a patient with a suspected rare genetic disorder where extensive family history review and genetic counseling are necessary, exceeding the scope of a standard A225 consultation.
- A220 is appropriate for a patient requiring a lengthy explanation of prenatal genetic screening results and implications, including a thorough discussion of follow-up testing and reproductive choices.
Common Pitfalls
- Billing A220 when the direct patient contact time is less than 75 minutes; this may result in the claim being reduced to a lesser assessment fee.
- Failing to document the start and stop times of the 75-minute direct patient contact in the medical record, which is a mandatory requirement for A220.
- Submitting A220 without a written request from a referring physician, nurse practitioner, or dental surgeon, as this referral is a prerequisite for billing.
Billing Tips
- Ensure the written report detailing findings, opinions, and recommendations is sent to the referring provider promptly after the A220 consultation.
- When billing virtually, remember to append 'A' to the code (A220A) and confirm the platform used was video-only.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultation
A written request from a referring physician, nurse practitioner, or dental surgeon is required.
A written report (including findings, opinions, and recommendations) must be sent to the referring provider.
The physician must spend a minimum of 75 minutes in direct contact with the patient (with or without family).
Start and stop times of the service must be recorded in the patient's permanent medical record.
A copy of the written request for the consultation, signed by the referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician’s medical record, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.
Calculation of time excludes non-patient-facing time such as time spent reviewing charts, imaging, or documentation.
Calculation of time excludes time devoted to any other service or procedure for which an amount is payable in addition to the consultation.
If the requirements for a special genetic consultation (e.g., time or documentation) are not met, the fee may be reduced to a lesser assessment fee.
In the event these requirements are not met, the amount payable for a consultation will be reduced to a lesser assessment fee.
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