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A174
A174 – Partial assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A partial assessment is a limited service that constitutes a history of the presenting complaint, the necessary physical examination, advice to the patient, and an appropriate record.
When to Use
- Use A174 for a focused history and physical examination addressing a single, new complaint, such as a recent minor injury or a specific symptom, where a full general assessment (A007) or specific assessment (A173) is not warranted.
- Bill A174 when providing advice and a brief examination for a patient presenting with a new, uncomplicated issue that requires a medical record entry but does not necessitate a comprehensive workup or referral.
- A174 is appropriate for follow-up of a resolved issue where the patient presents with a new, unrelated minor complaint requiring a separate, limited assessment.
Common Pitfalls
- Billing A174 on the same day as another assessment (e.g., A007, A173) by the same physician for the same patient is a common error and will result in rejection.
- Claiming A174 when the assessment is solely for the purpose of pre-procedure assessment, explanation, or consent is incorrect; these scenarios are typically covered by the procedure code itself or require a different type of visit code.
- Using A174 for a patient already admitted to hospital, when a different code (e.g., C174 for in-patient equivalent) might be more appropriate depending on the setting and physician's role.
Billing Tips
- When providing virtual care for a partial assessment, remember to append the 'A' suffix to A174 (i.e., A174A) to indicate a virtual encounter.
- A174 can be billed in conjunction with special visit premiums (K960-K964, K990-K997) if the criteria for a special visit, including travel and seeing additional patients, are met.
Provider Fee$0.00
Specialist Fee$24.10
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Consultations and Visits
Code Classes
Assessment
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