A093 – Specific assessment
OHIP General Listings Code — CARDIAC SURGERY (09) · Schedule of Benefits
A service rendered by a specialist in Cardiac Surgery (09) in a place other than a patient’s home, 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, and/or exclude disease, and/or assess function.
When to Use
- Bill A093 for a new cardiac surgery patient presenting with chest pain, requiring a detailed cardiac examination and history to rule out acute coronary syndrome.
- Use A093 when a patient requires a comprehensive assessment for a new diagnosis of valvular heart disease, including a focused physical exam and cardiac history.
- A093 is appropriate for a post-operative cardiac surgery patient requiring a specific assessment for a new, unrelated complication not covered by routine follow-up.
Common Pitfalls
- Billing A093 for hospital in-patients; C093 is the correct code in this setting.
- Claiming A093 on the same day as a counselling service (e.g., K013), which will result in rejection.
- Exceeding the one-per-patient-per-physician-per-12-month limit without clear documentation of a second, unrelated complaint, leading to payment adjustment.
Billing Tips
- If a patient requires a second specific assessment within 12 months for a clearly different and unrelated diagnosis, ensure documentation supports this to justify the second A093 claim.
- For virtual assessments, append the 'A' suffix to A093 to indicate the service was rendered remotely.
Effective: June 1, 2025
A. Consultations and Visits
CARDIAC SURGERY (09)
Consultations and Visits
Assessment
If usage limits are exceeded, the amount payable will be adjusted to a lesser assessment fee.
Special visit premiums (Travel and First Person Seen) may be applicable for non-elective visits to an office or outpatient department if criteria are met (see -).
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