A153 – Medical specific assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A medical specific assessment is a service rendered by a specialist in Endocrinology & Metabolism (15) in a place other than a patient’s home. It requires a full history of the presenting complaint and a detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis, and/or exclude disease, and/or assess function.
When to Use
- Use A153 for a specialist endocrinologist evaluating a new-onset thyroid nodule requiring a detailed neck examination and history, distinct from a general consultation (A150).
- Bill A153 when a patient requires a focused assessment for newly diagnosed diabetes insipidus, including history, physical, and initial management plan, differentiating it from a re-assessment (A154).
- A153 is appropriate for assessing a patient with suspected Cushing's syndrome, involving a specific history and examination related to endocrine signs, rather than a complex endocrine neoplastic disease assessment (A760) unless malignancy is suspected.
Common Pitfalls
- Billing A153 for routine follow-up of well-controlled endocrine conditions where a partial assessment (A158) or re-assessment (A154) would be more appropriate.
- Submitting A153 when the patient's condition is an uncomplicated endocrine disorder that falls under A760, leading to claim rejection.
- Exceeding the limit of one A153 per patient per physician per 12 months without meeting the criteria for a second assessment (unrelated diagnosis or 90-day interval with hospital admission).
Billing Tips
- Ensure documentation clearly outlines the specific presenting complaint, detailed history, and targeted physical examination supporting the need for a medical specific assessment.
- When billing a second A153 within 12 months, explicitly document the unrelated diagnosis or the 90-day interval and hospital admission context in the patient's chart.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Medical
Assessment
Full history of the presenting complaint.
Detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis, exclude disease, or assess function.
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