A023 – Specific Assessment
OHIP General Listings Code — Dermatology (02) · Schedule of Benefits
A specific assessment is a service rendered by a specialist in Dermatology (02) in a place other than the patient's home. It requires 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.
When to Use
- Bill A023 for a new patient presenting with a localized rash (e.g., contact dermatitis on the hands) requiring a focused history and examination, where no referral is present.
- Use A023 for a follow-up visit for a stable skin condition (e.g., acne management) where the complexity does not meet the criteria for A020 or A021.
- A023 is appropriate for a specialist dermatologist assessing a suspicious mole requiring a full history and examination of the affected area to rule out malignancy.
Common Pitfalls
- Billing A023 when the patient's condition meets the criteria for A020 (Complex dermatology assessment) or A021 (Advanced Dermatology Consultation), leading to under-billing.
- Exceeding the one-per-patient-per-physician-per-12-month limit without clear documentation of a distinct and unrelated second complaint, risking claim rejection or adjustment to A024.
- Billing A023 for simple follow-up visits or minor procedures that are included in the global fee of a previous assessment or should be billed using a different code.
Billing Tips
- If a patient presents with two distinct and unrelated new complaints within 12 months, ensure documentation clearly supports the second complaint as separate to justify billing A023 a second time.
- For virtual assessments, remember to append 'A' to the code (A023A) and ensure the documentation requirements for virtual care are met.
Effective: June 1, 2025
Consultations and Visits
Dermatology (02)
Consultations and Visits
Assessment
Full history of the presenting complaint.
Detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis, exclude disease, and/or assess function.
Direct physical encounter with the patient (unless billed as virtual care A023A).
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