A071 – Complex medical specific re-assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A complex medical specific re-assessment is a re-assessment of a patient because of the complexity, obscurity, or seriousness of the patient’s condition. It includes all the requirements of a medical specific re-assessment, which requires a full, relevant history and physical examination of one or more systems.
When to Use
- Bill A071 for a patient over 65 presenting with a new, complex neurological deficit requiring a detailed history and physical examination of the neurological system, with findings reported to their PCP.
- Use A071 when reassessing a patient with a previously diagnosed complex condition like advanced heart failure, where a thorough system review and documentation to the PCP are necessary.
- A071 is appropriate for a patient of any age presenting with significant cognitive decline suggestive of dementia, necessitating a comprehensive assessment and report to the primary physician.
Common Pitfalls
- Billing A071 for a routine follow-up or a simple problem that does not meet the 'complex, obscure, or serious' criteria, which may be better billed as A074 or A078.
- Failing to submit a written report of findings, opinions, or recommendations to the patient's primary care physician, which is a mandatory requirement for A071.
- Billing A071 for patients under 65 unless the assessment is specifically for dementia; other conditions in this age group require different assessment codes.
Billing Tips
- Ensure the patient's age is 65 or older, or that the assessment is for dementia, to meet the patient criteria for A071.
- Remember that A071 has a usage limit of 4 per patient per physician per 12 months, and exceeding this limit may result in the fee being adjusted to a lesser assessment code.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Geriatrics (07)
Assessment
The physician must report his/her findings, opinions, or recommendations in writing to the patient’s primary care physician.
Requires a full, relevant history and physical examination of one or more systems.
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