A221 – Genetic minor assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A minor assessment provided by a geneticist or a specialist with FCCMG designation, involving a brief history and examination or brief advice/information regarding health maintenance, diagnosis, treatment, and/or prognosis.
When to Use
- Use A221 for a brief genetic assessment of a patient with a known genetic condition, focusing on a specific health maintenance question.
- Bill A221 when a geneticist provides brief advice on the prognosis of a newly diagnosed genetic disorder, without a comprehensive review of systems.
- A221 is appropriate for a follow-up genetic assessment where the patient requires clarification on treatment options for a previously diagnosed condition.
Common Pitfalls
- Billing A221 when a more comprehensive assessment (e.g., A225 Consultation) is warranted due to the complexity or duration of the patient encounter.
- Submitting A221 for a service that primarily involves reviewing existing genetic test results without a distinct assessment component.
- Claiming A221 when the service is a simple follow-up phone call or message exchange, which may not meet the 'brief history and examination' or 'brief advice' criteria.
Billing Tips
- Ensure the medical record clearly delineates the 'brief history and examination' or 'brief advice/information' provided, distinguishing it from a full consultation.
- A221 is not eligible for payment with E078 (Genetic Counselling) or as a base code for E080 (Genetic Counselling Premium).
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Assessment
Must include one or both of: (a) a brief history and examination of the affected part or region or related to a mental or emotional disorder; or (b) brief advice or information regarding health maintenance, diagnosis, treatment and/or prognosis.
Must include the common and specific elements of an assessment as defined in the General Preamble.
A221 is listed under the Genetics (22) General Listings.
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