A112 – Periodic oculo-visual assessment - aged 65 years and above
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A periodic oculo-visual assessment is an examination of the eye and vision system rendered primarily to determine if a patient has a simple refractive error (defined as myopia, hypermetropia, presbyopia, anisometropia or astigmatism) for patients aged 19 or less or aged 65 or more. This service includes all components required to perform the assessment (ordinarily a history of the presenting complaint, past medical history, visual acuity examination, ocular mobility examination, slit lamp examination of the anterior segment, ophthalmoscopy, tonometry) advice and/or instruction to the patient and provision of a written refractive prescription if required.
When to Use
- Bill A112 for a patient aged 65 or older presenting for a routine eye exam to check for refractive errors like myopia or astigmatism, as this code specifically covers this demographic and purpose.
- Use A112 when the patient requires a comprehensive eye assessment including visual acuity, slit lamp exam, and ophthalmoscopy, and the patient meets the age criteria (65+).
- A112 is appropriate for a patient's first eye assessment after turning 65, provided it's within the 12-month limit and not for a condition already being managed by another specialist.
Common Pitfalls
- Billing A112 for a patient aged 20-64; this code is strictly for those 65 and older, and other assessment codes should be used for this age group.
- Submitting A112 more than once per patient within a 12-month period, as the usage limit is one per patient per year, regardless of the physician or optometrist providing the service.
- Billing A112 on the same day as another insured service (e.g., an intermediate assessment code like A110) by the same physician, unless the physician is an ophthalmologist.
Billing Tips
- Ensure the patient's chart clearly documents the components of the A112 assessment, including history, visual acuity, slit lamp exam, ophthalmoscopy, and tonometry, to support medical necessity.
- If a patient requires follow-up after an A112 assessment for a specific issue, use a lesser assessment code (e.g., A110) with diagnostic code 367, rather than attempting to re-bill A112.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments
All insured services must be documented in appropriate records. The record must establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
aged 65 years and above
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