A073 – Medical specific assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A medical specific assessment rendered by a specialist in Geriatrics (07), requiring 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
- Use A073 for a comprehensive geriatric assessment of a new patient presenting with multiple comorbidities and functional decline, distinct from a simple consultation (A375).
- Bill A073 when a Geriatrician performs a detailed assessment for a patient suspected of early-stage dementia, even if the patient is under 65.
- A073 is appropriate for a specialist in Geriatrics to assess a patient with a new diagnosis of Parkinson's disease requiring a detailed neurological and functional examination, not covered by a limited consultation (A375) or a repeat assessment (A074).
Common Pitfalls
- Billing A073 for a patient under 65 without a documented assessment specifically for dementia will lead to rejection.
- Submitting A073 claims more than once per patient per physician within 12 months without meeting the criteria for a second assessment (different diagnosis or 90-day gap for hospital admission) will result in claim adjustment.
- Claiming A073 for an in-patient assessment is incorrect; use C073 instead, as A073 is for out-patient services.
Billing Tips
- Ensure the documentation clearly outlines the 'full history of the presenting complaint' and 'detailed examination' to support the medical necessity of A073, differentiating it from less intensive assessment codes.
- A073 is eligible for the E078 Chronic Disease Assessment Premium if the patient has a documented chronic disease and the assessment is performed in an office or out-patient clinic setting, not in a hospital or emergency department.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Medical specific assessment
Assessment
Full history of the presenting complaint.
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.
A073 is eligible for payment for the assessment of dementia regardless of the patient's age.
Excess services beyond the usage limits will be adjusted to a lesser assessment fee.
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