A154 – Medical specific re-assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A service rendered by a specialist in Endocrinology & Metabolism requiring a full, relevant history and physical examination of one or more systems.
When to Use
- Bill A154 for a follow-up endocrinology consultation where a focused history and physical examination of one or more systems related to the patient's endocrine condition (e.g., thyroid, diabetes) are performed.
- Use A154 when a patient returns for a review of their endocrine management, and the assessment requires a detailed history and physical exam, differentiating it from a simpler follow-up visit (e.g., A007).
- A154 is appropriate for a specialist re-assessment of a patient with a new endocrine complication or a significant change in their existing condition, distinct from an initial consultation (A153) or a complex re-assessment (A151).
Common Pitfalls
- Billing A154 more than twice per patient per year without meeting the hospital admission exception can lead to claim adjustments or rejections.
- Submitting A154 on the same day as another consultation or assessment (e.g., A153, A151) by the same physician for the same patient is not permitted and will be rejected.
- Failure to document a full, relevant history and a physical examination of one or more systems in the patient's chart can result in audit issues if the service is reviewed.
Billing Tips
- A154 is eligible for the E078 Chronic Disease Assessment Premium if the patient has a documented chronic endocrine disease and the service is provided in an office or hospital out-patient clinic setting.
- Ensure the documentation clearly supports a 're-assessment' by detailing changes in the patient's condition, management, or response to treatment since the last assessment.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Medical
Assessment
Full, relevant history of the presenting complaint
Physical examination of one or more systems
Advice to the patient
Appropriate medical record documentation
Services in excess of the 12-month limit are adjusted to a lesser assessment fee
Admission assessments are deemed to be a specific re-assessment or medical specific re-assessment under either of the following circumstances: 1. for those procedures prefixed with a “Z” or noted as an IOP, by a surgical specialist who has assessed the patient prior to admission in respect of the same illness; or 2. for those patients who have been assessed by a physician and subsequently admitted to the hospital for the same illness by the same physician.
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