A074 – Medical specific re-assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A medical specific re-assessment is a service rendered by a specialist (Geriatrics) requiring a full, relevant history and physical examination of one or more systems.
When to Use
- Bill A074 for a geriatrician performing a comprehensive re-evaluation of a patient's multiple chronic conditions, including a detailed history and physical, to adjust their management plan.
- Use A074 when a specialist re-assesses a patient with dementia, even if they are under 65, provided a full history and physical examination are performed.
- A074 is appropriate when a specialist conducts a follow-up assessment for a patient previously seen for a specific condition, involving a relevant history and physical examination to assess progress or changes.
Common Pitfalls
- Billing A074 for a patient under 65 without a dementia diagnosis will result in rejection; ensure the patient meets the age or diagnosis criteria.
- Submitting A074 more than twice per patient per physician within a 12-month period without a specific exception (e.g., hospital admission) will lead to payment adjustment to a lesser assessment fee.
- Using A074 for hospital in-patients is incorrect; the correct code for this scenario is C074, which has the same billing requirements but is designated for in-patient services.
Billing Tips
- Geriatricians can bill the E078 Chronic Disease Assessment Premium in addition to A074 if the patient has a documented chronic disease and the assessment occurs in an office or hospital out-patient clinic setting.
- Ensure the documentation clearly reflects a 'full, relevant history and physical examination of one or more systems' to support the A074 claim, differentiating it from a partial assessment (A078).
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Office/Outpatient Visit
Assessment
Requires a direct physical encounter with the patient.
Must include a full, relevant history and physical examination of one or more systems.
Includes making arrangements for follow-up care and providing advice/information to the patient or representative.
As outlined on page , admission assessments are deemed to be a specific re-assessment or medical specific re-assessment under either of the following circumstances: 1. for those procedures prefixed with a “Z” or noted as an IOP, by a surgical specialist who has assessed the patient prior to admission in respect of the same illness; or 2. for those patients who have been assessed by a physician and subsequently admitted to the hospital for the same illness by the same physician.
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