A118 – Concurrent care
OHIP General Listings Code — CONSULTATIONS AND VISITS · 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. In addition to the common elements, all services which are described as assessments include the following specific elements: - A direct physical encounter with the patient including taking a patient history and performing a physical examination. - 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. - 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. - Making arrangements for any related assessments, procedures or therapy, and/or interpreting results. - Making arrangements for follow-up care. - 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 results of related procedures. - When medically indicated, monitoring the condition of the patient and intervening, until the next insured service is provided. - 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 A118 for a physician providing a partial assessment in their office, focusing on a specific presenting complaint, distinct from a full comprehensive assessment (e.g., K005).
- Use A118 when a physician performs a focused history and physical examination for a new problem, providing initial advice and management plan, without the extensive workup of a consultation code (e.g., K005).
- A118 is appropriate for follow-up visits where a new issue arises that requires a focused assessment, separate from routine follow-up of a stable chronic condition.
Common Pitfalls
- Billing A118 for a simple follow-up of a stable chronic condition; these should typically be billed as minor assessments (e.g., K001) or specific follow-up codes if applicable.
- Using A118 when the service provided was a consultation (e.g., K005) requiring a more in-depth history, examination, and opinion on a complex problem.
- Failure to document the specific elements of a partial assessment, including history of presenting complaint, physical exam, advice, and record keeping, leading to potential audit issues.
Billing Tips
- Ensure the documentation clearly distinguishes the focused nature of the A118 assessment from a comprehensive consultation (K005) or a minor assessment (K001).
- A118 can be billed with applicable premiums such as the Chronic Disease Assessment Premium (if criteria met) or the Trauma Premium (E420) when appropriate and documented.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments
A partial assessment requires documentation of a history of the presenting complaint, the necessary physical examination, advice to the patient, and an appropriate record.
The start and stop times must be recorded in the patient’s permanent medical record.
For the Trauma Premium (E420), the medical record must list the Injury Severity Score (ISS).
For the Chronic Disease Assessment Premium, the patient's established diagnosis of a chronic disease must be documented in the patient's medical record.
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