A203 – Specific assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A service rendered by a specialist in a place other than a patient’s home, requiring a full history of the presenting complaint and detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis, and/or exclude disease, and/or assess function.
When to Use
- Bill A203 for a specialist's initial comprehensive assessment of a new, complex dermatological condition requiring a detailed history and examination of the affected skin regions.
- Use A203 when a specialist performs a full assessment of a patient's newly diagnosed cardiac arrhythmia, including history, physical exam, and review of initial investigations, to establish a diagnostic and treatment plan.
- A203 is appropriate for a specialist's initial assessment of a patient presenting with symptoms suggestive of a neurological disorder, involving a thorough history and detailed neurological examination.
Common Pitfalls
- Billing A203 when the service provided is a more limited assessment, such as a follow-up of a stable condition, which might be better billed as A204 (Partial assessment) or A205 (Consultation).
- Submitting A203 for a patient's second assessment within 12 months for the same condition without meeting the criteria for an increased limit (e.g., a clearly different diagnosis or a hospital admission assessment after 90 days).
- Failing to document the 'full history of the presenting complaint' and 'detailed examination of the affected part(s), region(s), or system(s)' as required, leading to potential audits or claim rejections.
Billing Tips
- Ensure the documentation clearly distinguishes the A203 assessment from a routine follow-up visit (A205) by detailing the comprehensive nature of the history and examination performed.
- When an E432 (Pelvic exam including speculum) is performed by the same physician on the same day as an A203, ensure only one E432 is billed, as it is limited to one per patient per day.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Assessment
Full history of the presenting complaint.
Detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis, and/or exclude disease, and/or assess function.
Specific assessments are services rendered by specialists in a place other than a patient's home.
The amount payable for assessments in excess of the 12-month limit will be adjusted to a lesser assessment fee.
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