A020 – Complex Dermatology Assessment
OHIP General Listings Code — Dermatology (02) · Schedule of Benefits
An assessment for the ongoing management of complex dermatological conditions where the complexity of the condition requires continuing management by a dermatology specialist.
When to Use
- Bill A020 for the ongoing management of a patient with SLE presenting with significant skin manifestations requiring specialist dermatological input.
- Use A020 when managing a patient with prurigo nodularis that has not responded to initial treatments and requires specialist intervention.
- A020 is appropriate for a patient with a complex psoriasis affecting over 30% BSA or requiring systemic therapy such as biologics.
Common Pitfalls
- Billing A020 for a new diagnosis of a common skin condition that does not meet the complexity criteria, leading to adjustment to A023.
- Exceeding the limit of 6 A020 services per patient per 12 months without meeting criteria for further complex assessments, resulting in adjustment to A024.
- Failing to document the specific complex condition (e.g., specifying BSA > 30% for psoriasis, or T1b+ for melanoma) leading to potential audit issues or fee adjustment.
Billing Tips
- Ensure documentation clearly outlines the specific complex dermatological condition and the rationale for ongoing specialist management, differentiating it from a standard assessment (A023).
- When the 15-minute direct contact time is used to meet the complexity criteria for psoriasis or dermatitis, ensure this time is accurately recorded and excludes time spent on other services or documentation.
Effective: June 1, 2025
Consultations and Visits
Dermatology (02)
Specialist Assessment
Assessment
Must include all elements of a 'Specific Assessment': a full history of the presenting complaint and a detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis, exclude disease, and/or assess function.
The service must be for the ongoing management of one of the following complex conditions:
1. Complex systemic disease with skin manifestations (e.g., sarcoidosis, SLE, dermatomyositis, scleroderma, relapsing polychondritis, IBD with pyoderma gangrenosum/Sweet's/erythema nodosum, porphyria, autoimmune blistering diseases, paraneoplastic syndromes, vasculitis, cutaneous lymphomas).
2. Prurigo nodularis.
3. Complex systemic drug reactions (e.g., drug hypersensitivity syndrome, erythema multiforme major, toxic epidermal necrolysis).
4. Complex psoriasis or complex dermatitis (defined by BSA > 30%, treatment with systemic therapy like biologics/methotrexate, or a visit requiring at least 15 minutes of direct contact).
5. Complex skin cancer or high risk (e.g., high-risk melanoma T1b+, morpheic BCC, SCC stage 2+, field cancerization with 10+ actinic keratoses, multiple dysplastic nevi meeting specific criteria, or other neoplasms requiring pathology diagnosis).
If the service does not include all elements of a specific assessment, the fee will be adjusted to a lesser assessment fee.
Calculation of time (where applicable for the 15-minute criteria) excludes time devoted to other payable services and non-patient-facing time (e.g., chart review, documentation).
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