A193 – Specific assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A specific assessment is a service rendered by a specialist in Psychiatry, in a place other than a patient’s home, requiring 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, exclude disease, and/or assess function.
When to Use
- Bill A193 for a psychiatrist's initial, in-depth assessment of a patient presenting with a new complex anxiety disorder, including a detailed psychiatric history and mental status examination.
- Use A193 when a psychiatrist performs a comprehensive diagnostic assessment for a patient with suspected early-onset dementia, requiring a thorough cognitive and neurological examination.
- A193 is appropriate for a psychiatrist's detailed assessment of a patient with treatment-resistant depression, involving a full history of symptoms, past treatments, and a functional capacity evaluation.
Common Pitfalls
- Billing A193 on the same day as K007, K197, or K013 without clearly documented, distinct diagnoses for each service will lead to rejection of one or more codes.
- Submitting A193 more than once per patient per 12-month period without meeting the criteria for a second assessment (unrelated diagnosis or 90+ days with hospital admission assessment) will result in reduced payment.
- Attempting to bill A193 for a service that is primarily a follow-up or management session, rather than a distinct, comprehensive diagnostic assessment, is incorrect coding.
Billing Tips
- Ensure your documentation clearly outlines the 'full history of the presenting complaint' and 'detailed examination of the affected part(s), region(s), or system(s)' to support the specific nature of the A193 assessment.
- Remember that A193 is an assessment, not a consultation; therefore, a formal referral is not required, but the service must be rendered by a specialist in Psychiatry.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Psychiatry
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, and/or assess function.
Appropriate record of the service.
A193 is an assessment, not a consultation; therefore, it does not require a formal referral from another physician.
A193 is not eligible for the Psychiatric Consultation Extension (K630).
A193 is not eligible for the Chronic Disease Assessment Premium (specialty 19 is not listed).
A193 is not eligible for Age-based fee premiums (these apply to consultations or specific assessments in Ophthalmology only).
A193 is not eligible for the First Visit After Hospital Discharge Premium (E080).
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