A244 – Partial assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A partial assessment is the limited service that constitutes a history of the presenting complaint, the necessary physical examination, advice to the patient and appropriate record. Specific Elements of Assessments In addition to the common elements, all services which are described as assessments, or as including assessments (e.g. consultations), include the following specific elements: A. A direct physical encounter with the patient including taking a patient history and performing a physical examination. B. Other inquiry (including taking a patient history), carried out to arrive at an opinion as to the nature of the patient's condition, (whether such inquiry takes place before, during or after the encounter during which the physical examination takes place) and/or follow-up care. C. Performing any procedure(s) during the same encounter as the physical examination, unless the procedure(s) is(are) separately listed in the Schedule and an amount is payable for the procedure in conjunction with an assessment. D. Making arrangements for any related assessments, procedures or therapy, and/or interpreting results. E. Making arrangements for follow-up care. F. Discussion with, and providing advice and information, including prescribing therapy to the patient or the patient's representative, whether by telephone or otherwise, on matters related to: 1. the service; and 2. in circumstances in which it would be professionally appropriate that results can be reported upon prior to any further patient visit, the results of related procedure(s) and/or assessment(s). G. When medically indicated, monitoring the condition of the patient and intervening, until the next insured service is provided. H. Providing premises, equipment, supplies, and personnel for the specific elements of the service except for any aspect(s) that is (are) performed in a hospital or nursing home.
When to Use
- Bill A244 for a patient presenting with a new, localized complaint (e.g., a specific rash, a sore throat) that requires a focused history, examination, and advice, but not a comprehensive assessment (e.g., A007).
- Use A244 when a patient returns for follow-up on a minor, resolved issue where a brief history, limited exam, and confirmation of resolution are all that is required, and a full reassessment is not medically necessary.
- A244 is appropriate for a patient seen in the physician's office for a new symptom that is not part of a chronic disease management plan, where the service is limited to history, exam, and advice.
Common Pitfalls
- Billing A244 when the service provided was a simple follow-up for a previously assessed condition without a new complaint or significant change, which might be better billed as an intermediate assessment (e.g., A001) or a minor assessment (e.g., A005).
- Avoid using A244 if the patient encounter involved a significant new problem requiring a more extensive history and physical, which would warrant a general assessment (e.g., A007) or a consultation code (e.g., A001, A003).
- Rejection may occur if A244 is billed on the same day as a procedure code that already includes assessment components, unless the procedure is separately listed and payable with an assessment.
Billing Tips
- Ensure the documentation clearly distinguishes the limited scope of the history and examination performed, supporting the 'partial' nature of the assessment.
- When A244 is billed, confirm that the service provided was not a more complex assessment or consultation, and that the documentation reflects the limited nature of the encounter.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments
A partial assessment requires an appropriate record.
All insured services must be documented in medical records to establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
This is a General Listing and is used for services rendered in a physician's office, or when a physician who is in a hospital but not on duty in the Emergency Department sees patients in the Emergency or Out-Patient Department. It is also used in conjunction with special visit premiums.
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