A151 – Complex medical specific re-assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A complex medical specific re-assessment is a re-assessment of a patient because of the complexity, obscurity, or seriousness of the patient’s condition. It includes all the requirements of a medical specific re-assessment (a full, relevant history and physical examination of one or more systems).
When to Use
- Bill A151 when a patient with a rare endocrine disorder presents with new, complex symptoms requiring a detailed history and physical examination of multiple systems, beyond what A154 would cover.
- Use A151 for a patient with a previously diagnosed, complex endocrine condition (e.g., Cushing's disease with multiple comorbidities) who requires a thorough re-evaluation due to worsening or atypical presentation.
- A151 is appropriate for a patient with a poorly understood endocrine issue that has resisted initial management, necessitating a deep dive into their history and a comprehensive physical exam of relevant systems.
Common Pitfalls
- Failure to submit a written report of findings, opinions, or recommendations to the patient's primary care physician will result in the fee being adjusted to a lesser assessment fee, likely A154.
- Billing A151 more than 4 times per patient per 12-month period, in combination with A153, will lead to services in excess of the limit being adjusted to a lesser assessment fee.
- Using A151 for an in-patient assessment; C151 is the correct code for in-patient services, and A151 will be rejected or adjusted.
Billing Tips
- Ensure the written report to the primary care physician clearly outlines the complexity, obscurity, or seriousness of the patient's condition that necessitated this specific re-assessment.
- When billing virtually, append the 'A' suffix and confirm all requirements for Comprehensive Virtual Care (video or telephone) are met, including a detailed history and physical examination.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Office or Out-patient
Assessment
Must include a full, relevant history and physical examination of one or more systems.
The physician must report his/her findings, opinions, or recommendations in writing to the patient’s primary care physician or the amount payable for the service will be adjusted to a lesser assessment fee.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.