A204 – 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 creation of an appropriate medical record.
When to Use
- Bill A204 for a patient presenting with a new, isolated complaint (e.g., a sore throat) requiring a focused history, physical exam, and advice, without the complexity of a full assessment (A203).
- Use A204 when a physician in the Emergency Department or Out-Patient Department sees a patient who is not admitted or referred, and the encounter involves a limited assessment of a specific problem.
- A204 is appropriate for a follow-up visit for a minor issue where the physician re-evaluates the presenting complaint, provides further advice, and documents the encounter, but does not perform a comprehensive assessment.
Common Pitfalls
- Billing A204 instead of a more comprehensive assessment code (A203) when the patient's condition and the physician's work involved a broader scope of history and examination.
- Submitting A204 for a patient encounter that is primarily a follow-up of a previously assessed condition, which might be better represented by a repeat consultation (A206) or specific assessment (A203) depending on the work performed.
- Claiming A204 when the service provided was a simple inquiry or advice without a physical examination, which does not meet the requirements for this code.
Billing Tips
- Ensure the documentation clearly outlines the specific presenting complaint, the limited examination performed, and the advice provided to justify the use of A204 over a more general assessment code.
- When performing a pelvic exam outside a hospital setting, consider billing the appropriate add-on code (E432) in conjunction with A204, provided all eligibility criteria are met.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation and Visit
Assessment
History of the presenting complaint.
Necessary physical examination.
Advice to the patient.
Appropriate medical record.
Direct physical encounter with the patient (unless provided via virtual care).
Used for office or Out-Patient Department (OPD) visits.
Physicians in hospital but not on duty in the Emergency Department use this code when seeing patients in the Emergency or OPD.
Special visit premiums (Travel and First Person Seen) may be applicable if rendered in an OPD or Emergency Department, subject to general preamble restrictions.
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