All codes
A168
A168 – Partial assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A partial assessment is a limited medical service that includes a history of the patient's presenting complaint, the necessary physical examination, advice to the patient, and the maintenance of an appropriate medical record.
When to Use
- Use A168 for a focused follow-up visit addressing a specific new complaint in a nephrology patient, where a full system review is not warranted.
- Bill A168 for a brief check-in on a stable nephrology patient to review recent lab results and adjust medication, without performing a comprehensive examination.
- A168 is appropriate for a patient presenting with a new, isolated symptom (e.g., mild edema) requiring a targeted history, limited exam, and advice, distinct from a more complex re-assessment (A164).
Common Pitfalls
- Billing A168 on the same day as a more comprehensive assessment (e.g., A163) or consultation by the same physician for the same patient will likely result in rejection.
- Failure to add the E060 premium when billing for post-renal transplant care within the first three years post-transplant, if the criteria are met, is a missed revenue opportunity.
- Using A168 for a patient encounter that truly warrants a Medical Specific Re-assessment (A164) or Complex Medical Specific Re-assessment (A161) may lead to under-billing.
Billing Tips
- Ensure documentation clearly outlines the focused nature of the history, examination, and advice provided, differentiating it from a more extensive assessment.
- When applicable, append the E060 premium for post-renal transplant care within the first three years to accurately reflect the complexity of the service.
Provider Fee$0.00
Specialist Fee$38.55
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Consultations and Visits
Code Classes
Assessment
History of the presenting complaint.
Necessary physical examination.
Advice to the patient.
Appropriate record.
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