A083 – Specific assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A specific assessment is a service rendered by a specialist 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. In addition to the common elements, all services which are described as assessments, or as including assessments (e.g. consultations), include the following specific elements: - A. A direct physical encounter with the patient including taking a patient history and performing a physical examination. - B. Other inquiry (including taking a patient history), carried out to arrive at an opinion as to the nature of the patient's condition, (whether such inquiry takes place before, during or after the encounter during which the physical examination takes place) and/or follow-up care. - C. Performing any procedure(s) during the same encounter as the physical examination, unless the procedure(s) is(are) separately listed in the Schedule and an amount is payable for the procedure in conjunction with an assessment. - D. Making arrangements for any related assessments, procedures or therapy, and/or interpreting results. - E. Making arrangements for follow-up care. - F. Discussion with, and providing advice and information, including prescribing therapy to the patient or the patient's representative, whether by telephone or otherwise, on matters related to: the service; and in circumstances in which it would be professionally appropriate that results can be reported upon prior to any further patient visit, the results of related procedure(s) and/or assessment(s). - G. When medically indicated, monitoring the condition of the patient and intervening, until the next insured service is provided. - H. Providing premises, equipment, supplies, and personnel for the specific elements of the service except for any aspect(s) that is (are) performed in a hospital or nursing home.
When to Use
- Bill A083 for a specialist's initial assessment of a patient's complex dermatological condition in their private office, including a detailed history and examination of the affected skin areas.
- Use A083 when a neurologist performs a comprehensive neurological assessment in their clinic for a patient presenting with new-onset seizures, involving a full history, neurological exam, and initial management plan.
- A083 is appropriate for a cardiologist's assessment of a patient with exertional chest pain in their office, requiring a thorough cardiac history, physical exam, and review of initial investigations.
Common Pitfalls
- Billing A083 for a follow-up visit; this code is intended for initial specific assessments, not subsequent management of established conditions.
- Submitting A083 when the service is performed in a hospital or nursing home; these settings typically require different assessment codes or premiums.
- Claiming A083 when another specialist has already performed a similar specific assessment for the same presenting complaint during the same visit; only one assessment is payable per physician per visit.
Billing Tips
- Ensure the medical record clearly documents the full history of the presenting complaint and a detailed examination of the affected part(s), region(s), or system(s) to justify the A083 assessment.
- A083 can be billed in conjunction with eligible special visit premiums (e.g., E420 Trauma premium) if the criteria for both codes are met.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments
Requires a full history of the presenting complaint and 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. See .
The medical record must establish that an insured service was provided, the service claimed is the service that was rendered, and the service was medically necessary. See .
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