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A234
A234 – Ophthalmology partial assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A partial assessment is a limited service that constitutes a history of the presenting complaint, the necessary physical examination, advice to the patient, and an appropriate record. It is rendered by a specialist in ophthalmology.
When to Use
- Bill A234 for a focused history and examination of a specific ophthalmological complaint, such as sudden vision loss or acute eye pain, where a full assessment (A233) is not warranted.
- Use A234 when a patient presents for a limited follow-up of a specific ophthalmological issue, and the encounter does not meet the criteria for a more comprehensive assessment code.
- A234 is appropriate for a specialist ophthalmologist to assess a new, isolated ophthalmological problem that does not require a full workup, differentiating it from a general assessment code like A115.
Common Pitfalls
- Billing A234 when the service provided is a routine eye exam for glasses or contacts; these typically require codes like A233 or specific refraction codes.
- Claiming A234 on the same day as A250, A252, or A254 is prohibited and will result in rejection.
- Failure to document the specific presenting complaint, examination findings, and advice provided can lead to audits if the service is deemed not to meet the 'partial assessment' criteria.
Billing Tips
- A234 is eligible for age-based premiums (e.g., AGE_PREMIUM_LESS_30_DAYS, AGE_PREMIUM_30_DAYS_TO_1_YEAR) when billed by an ophthalmologist for qualifying pediatric patients.
- Consider add-on codes like E423 (Manual cycloplegic refraction) for patients 15 years or younger, or E424 (Assessment of paediatric patient with amblyopia) for eligible children, when performed in conjunction with A234.
Provider Fee$0.00
Specialist Fee$30.50
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Ophthalmology
Code Classes
Assessment
History of the presenting complaint.
Necessary physical examination.
Advice to the patient.
Appropriate record.
Direct physical encounter (unless billed as virtual care).
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