A802 – Extended midwife or aboriginal midwife-requested genetic assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This service is the assessment provided by a geneticist upon the written request of a midwife or aboriginal midwife because of the complex, obscure or serious nature of the patient’s problem. This service includes the specific elements of an assessment and the physician must spend a minimum of 90 minutes in direct contact with the patient, exclusive of time spent rendering any other separately billable intervention to the patient.
When to Use
- Bill A802 when a midwife requests a genetic assessment for a patient with a suspected rare genetic syndrome requiring extensive discussion and review of complex pedigrees, exceeding the 75-minute requirement of A801.
- Use A802 if the patient's genetic condition involves multiple organ systems and requires a detailed explanation of advanced genetic testing options, necessitating over 90 minutes of direct patient contact.
- A802 is appropriate when a midwife requests a genetic assessment for a patient with a history of multiple unexplained pregnancy losses due to suspected chromosomal abnormalities, requiring a lengthy consultation.
Common Pitfalls
- Failure to document the exact start and stop times of the 90-minute direct patient contact in the patient's chart will lead to reduced payment.
- Submitting A802 without retaining the written request from the midwife in the patient's record will result in a reduced fee.
- Billing A802 when the direct patient contact time is less than 90 minutes, or if other separately billable services were performed during that same contact period, will lead to rejection.
Billing Tips
- Ensure the written report detailing findings and recommendations is sent to both the requesting midwife and the patient's primary care provider to avoid payment reduction.
- A802 can be billed with K229 (Complex genetic test interpretation) if the interpretation is separate from the direct patient assessment time, but not on the same day as K223 or K224.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Midwife-requested assessment
Assessment
The written request from the midwife or aboriginal midwife must be retained on the patient’s permanent medical record, or the amount payable for the service will be reduced to a lesser fee.
The geneticist must submit his/her findings, opinions and recommendations in writing to both the midwife or aboriginal midwife and the patient’s primary care physician or nurse practitioner, if applicable, or the amount payable for the service will be reduced to a lesser fee.
The service is eligible for payment only if start and stop times of the service are recorded in the patient's permanent medical record.
The calculation of time for A802 excludes (1) time devoted to any other service or procedure for which an amount is payable in addition to the assessment and (2) non-patient-facing time such as time spent reviewing charts, imaging, or documentation, etc.
Eligible for Special Visit Premiums (Travel and First Person Seen) if the visit is non-elective and requires travel to a hospital or patient's home.
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