A239 – Periodic oculo-visual assessment - aged 65 years and above
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A periodic oculo-visual assessment is an examination of the eye and vision system rendered primarily to determine if a patient has a simple refractive error (defined as myopia, hypermetropia, presbyopia, anisometropia or astigmatism) for patients aged 65 or more.
When to Use
- Bill A239 for an ophthalmologist performing a comprehensive eye exam on a 70-year-old patient to assess for refractive error, provided it's been at least 12 months since their last A239 or A112.
- Use A239 when a patient 65+ presents for a routine check of their vision and refractive status, including refraction, slit lamp, and fundus exam, and this is their only insured eye exam within a 12-month period.
- A239 is appropriate for an ophthalmologist assessing a 65-year-old patient with new symptoms of blurry vision, where the primary goal is to determine if a refractive change is the cause, and other specific ophthalmology codes (e.g., for acute conditions) are not applicable.
Common Pitfalls
- Billing A239 more than once in a 12-month period for the same patient, even if performed by different physicians or optometrists, will lead to rejection as it exceeds the usage limit.
- Submitting A239 for a patient aged 20-64; this age group requires A115 for a major eye examination.
- Claiming A239 when the patient's primary complaint or the physician's focus is on a specific ocular disease or condition, rather than a simple refractive error assessment; other specialized ophthalmology codes would be more appropriate in such cases.
Billing Tips
- Ensure all required components listed under 'Requirements' are documented in the patient's chart to support the A239 claim.
- If an ophthalmologist performs an A239, remember that other insured services by the same physician on the same day are not eligible for payment, unless they are ophthalmologist-specific services not covered by A239.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Ophthalmology
Assessment
aged 65 years and above
Services in excess of the 12-month limit or to patients aged 20 to 64 are not insured services.
Other consultation and visit codes are not to be used as a substitute for this service when the limit is reached.
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