All codes
A194
A194 – Partial assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A partial assessment is the limited service that constitutes a history of the presenting complaint, the necessary physical examination, advice to the patient and appropriate record.
When to Use
- Bill A194 for a brief follow-up appointment focusing on a single, specific complaint, such as a medication review for a stable chronic condition.
- Use A194 when a patient presents with a new, isolated symptom requiring a focused history, limited exam, and immediate advice, without the complexity of a full assessment (A193).
- A194 is appropriate for a quick check-in after a procedure to assess for immediate post-operative issues, provided it doesn't constitute a comprehensive follow-up visit.
Common Pitfalls
- Billing A194 on the same day as another assessment or consultation (e.g., A193) for the same patient without a distinctly different diagnosis will lead to rejection.
- Submitting A194 for a service that primarily involves psychotherapy or counseling, especially if the visit exceeds 20 minutes, as this should be billed under a psychotherapy code.
- Attempting to bill A194 with the Psychiatric Consultation Extension (K630) is not permitted and will result in a claim rejection.
Billing Tips
- For virtual care, remember to append the correct modality indicator: K300A for video or K301A for telephone.
- Ensure the documentation clearly outlines the specific presenting complaint, the limited examination performed, and the advice provided to justify the partial assessment.
Provider Fee$0.00
Specialist Fee$41.15
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Medical
Code Classes
Assessment
History of presenting complaint
Necessary physical examination
Advice to the patient
Appropriate medical record
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