A043 – Specific Assessment
OHIP General Listings Code — Neurosurgery (04) · Schedule of Benefits
A specific assessment is a service rendered by a specialist in Neurosurgery (04) in a place other than a 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, and/or exclude disease, and/or assess function.
When to Use
- Bill A043 for a neurosurgeon evaluating a patient in their office for new-onset, severe headaches that may indicate a subarachnoid hemorrhage, requiring a detailed neurological exam and history to confirm or rule out this diagnosis.
- Use A043 when a neurosurgeon performs a specific assessment in their outpatient clinic for a patient with a new spinal cord lesion identified on imaging, necessitating a thorough history and focused examination to determine the cause and plan management.
- A043 is appropriate for a neurosurgeon assessing a patient in the hospital's Outpatient Department (OPD) for a post-operative complication, such as wound dehiscence or neurological deficit, requiring a detailed examination to diagnose and manage the issue.
Common Pitfalls
- Billing A043 for a follow-up visit to monitor a stable condition; this should be billed as a partial assessment (A044) or a general assessment if appropriate.
- Submitting A043 for a patient seen in their home; this service is explicitly for non-home settings and would not be eligible.
- Using A043 for a patient admitted to the hospital; the correct code for an in-patient specific assessment is C043.
Billing Tips
- If a neurosurgeon sees a patient for a second, unrelated complaint within 12 months, ensure the documentation clearly supports a distinct diagnosis to justify billing A043 again.
- When performing a virtual assessment for A043, remember to append the 'A' suffix to the billing code.
Effective: June 1, 2025
Consultations and Visits
Neurosurgery (04)
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.
Must be rendered in a place other than the patient's home (e.g., office or outpatient department).
A043 is not eligible for Age-based fee premiums (percentage increases) under .
Neurosurgery (04) is not an eligible specialty for the Chronic Disease Assessment Premium.
If the physician is in the hospital but not on duty in the Emergency Department, A043 should be used for assessments in the Emergency or OPD.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.