A113 – Complex neuromuscular assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
An assessment for the ongoing management of complex chronic neurological conditions where the complexity of the condition requires the continuing management by a neurologist and where the visit requires a minimum of 20 minutes in direct contact with the patient, exclusive of time spent rendering any other separately billable intervention.
When to Use
- Bill A113 for a patient with established Huntington's chorea requiring a detailed neurological re-assessment and management plan, provided the visit exceeds 20 minutes and includes documented start/stop times.
- Use A113 for ongoing management of a patient with a diagnosed motor neurone disease who presents for a complex neurological assessment, ensuring the visit includes a relevant history and physical exam.
- A113 is appropriate for a patient with a CNS metastasis requiring ongoing neurological management, where the physician spends at least 20 minutes in direct contact and documents the encounter's duration.
Common Pitfalls
- Billing A113 for initial evaluations of patients with neurological conditions; use a consultation code (e.g., G001) instead.
- Claiming A113 for routine follow-ups of uncomplicated neurological disorders like carpal tunnel syndrome, which are not covered by this code.
- Failure to record start and stop times in the patient's medical record can lead to payment adjustments to a lesser assessment fee.
Billing Tips
- Ensure the patient's medical record clearly documents the specific chronic complex neurological condition (e.g., myopathy, stroke) that justifies the A113 assessment.
- Verify that the visit meets the minimum 20-minute direct patient contact requirement and includes a relevant history and physical examination before submitting A113.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Neurology
Assessment
If the service does not include the elements of a medical specific re-assessment, the amount payable will be adjusted to a lesser assessment fee.
If start and stop times are not recorded, the amount payable will be adjusted to a lesser paying fee.
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