A233 – Specific assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A specific assessment is a service rendered by a specialist, in a place other than a patient’s home, that requires 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 A233 for an ophthalmologist's focused evaluation of a patient presenting with new-onset diplopia, requiring a detailed history of the visual disturbance and a targeted neurological and ocular examination.
- Use A233 when an ophthalmologist performs a comprehensive assessment of a patient with a suspected retinal detachment, including dilated fundus examination and visual field testing, to confirm or exclude the diagnosis.
- A233 is appropriate for an ophthalmologist assessing a patient with a suspected orbital tumor, involving a detailed history, palpation, assessment of extraocular movements, and visual acuity testing.
Common Pitfalls
- Billing A233 for a routine follow-up visit that does not involve a new presenting complaint or a significant change in management, as this would be more appropriately billed as a partial assessment (A234) or a general assessment.
- Submitting A233 when the assessment is primarily a refraction or vision screening, which should be billed using different codes, potentially with add-on codes like E423 if applicable.
- Failing to document the specific findings of the history and examination that support the need for a 'specific' assessment, leading to potential audit issues.
Billing Tips
- Ensure the documentation clearly distinguishes the assessment from a general consultation (A235) by detailing the focused history and examination of the affected area.
- Remember that A233 can be billed up to twice per patient per physician per 12-month period if a second, unrelated diagnosis is made during a subsequent specific assessment.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Assessment
Requires a full history of the presenting complaint.
Requires a detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis, exclude disease, and/or assess function.
Must be rendered personally by the ophthalmologist.
A233 is eligible for age-based fee premiums as per the Age Premium Table in the General Preamble.
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