A138 – Partial assessment
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.
When to Use
- Bill A138 for a patient presenting with a new, isolated symptom (e.g., a specific rash) where a focused history, limited exam, and brief advice are provided, rather than a comprehensive assessment like GP21.
- Use A138 when a patient requires a brief follow-up on a specific issue post-procedure, but the complexity does not warrant a full follow-up assessment code (e.g., checking a wound dressing after a minor procedure).
- A138 is appropriate for a patient seeking advice on a single, non-urgent health concern that requires a focused history and examination, but not a full diagnostic workup or management plan.
Common Pitfalls
- Billing A138 on the same day as another assessment code (e.g., GP21, GP23) by the same physician will lead to rejection, as only one assessment per physician per day is permitted.
- Claiming A138 when the service provided meets the criteria for a more comprehensive assessment (e.g., GP21 or a Medical Specific Assessment like GP23) can result in an audit or claim review.
- Failure to document the specific presenting complaint, the limited examination performed, and the advice given can lead to rejection if the service is audited.
Billing Tips
- If providing virtual care for a partial assessment, remember to append the 'A' suffix (A138A) to the billing code.
- A138 can be eligible for the Chronic Disease Assessment Premium (E078) for Internal Medicine specialists (specialty 13) if all other criteria are met, but is not eligible for Age-based fee premiums (GP64) or the Hospitalist Premium (GP103).
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Assessment
A138 is specifically listed under Internal Medicine (13) General Listings.
Eligible for the Chronic Disease Assessment Premium (E078) for specialty 13 (Internal Medicine) as it is a partial assessment and specialty 13 is in the designated specialty list on , provided other criteria are met.
Not eligible for Age-based fee premiums ().
Not eligible for the Hospitalist Premium ().
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.