All codes
A094
A094 – Partial assessment
OHIP General Listings Code — CARDIAC SURGERY (09) · Schedule of Benefits
A partial assessment is the limited service that constitutes a history of the presenting complaint, the necessary physical examination, advice to the patient and appropriate record.
When to Use
- Bill A094 for a focused cardiac surgery-related complaint in the emergency department or outpatient department when the physician is not on duty in the ED.
- Use A094 for a brief follow-up of a specific cardiac surgical issue that does not meet the criteria for a full consultation (A095) or specific assessment (A093).
- A094 is appropriate for a patient presenting with a new, isolated cardiac surgical concern requiring a history, limited exam, and advice, distinct from a comprehensive initial assessment.
Common Pitfalls
- Submitting A094 on the same day as a consultation (A095) or specific assessment (A093) by the same physician for the same patient will result in rejection.
- Billing A094 for a service that constitutes a full assessment or consultation may lead to audit adjustments, as it is intended for limited services.
- Failure to document the history, examination, and advice provided will make the claim vulnerable to audit and potential recoupment.
Billing Tips
- Submit A094 with suffix 'A' when providing the service virtually to ensure correct payment and tracking.
- Ensure the service provided is truly a 'partial' assessment; if it involves a comprehensive workup, consider A095 or A093 instead.
Provider Fee$0.00
Specialist Fee$25.30
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CARDIAC SURGERY (09)
Service Type
Consultations and Visits
Code Classes
Assessment
History of the presenting complaint.
Necessary physical examination.
Advice to the patient.
Appropriate medical record.
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