A251 – Special ophthalmologic assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A complete ophthalmologic assessment, rendered by an ophthalmologist, to a person with a psychological problem, developmental delay, learning disability, or significant physical disability which so limits the person’s participation in the assessment that the physician is required to spend a minimum of 20 minutes in direct contact with the patient, family, and/or legal representative, exclusive of time spent rendering any other separately billable intervention to the patient.
When to Use
- Bill A251 for an ophthalmologist's comprehensive assessment of a child with autism spectrum disorder who requires significantly extended direct interaction time due to communication challenges.
- Use A251 when evaluating a patient with cerebral palsy whose physical limitations necessitate a prolonged assessment period to ensure adequate examination and patient understanding.
- A251 is appropriate for an ophthalmologist assessing a young patient with a significant developmental delay and low vision, where the complexity requires over 20 minutes of direct patient/family contact.
Common Pitfalls
- Failure to document the start and stop times of the patient encounter in the medical record will result in the fee being reduced.
- Billing A251 when the patient's condition does not genuinely limit their participation in a standard assessment, leading to potential audits.
- Including time spent on other separately billable procedures or non-patient-facing tasks when calculating the minimum 20 minutes required for A251.
Billing Tips
- Ensure the medical record clearly states the patient's specific condition and how it impedes their ability to participate in a standard eye assessment to justify the extended time.
- Maintain a copy of the written report provided to other healthcare team members in the patient's chart to meet documentation requirements for A251.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Assessment
the development of a continuing comprehensive vision care plan;
provision of appropriate information to the patient’s health care team regarding the patient’s vision to allow them to better prepare both general and academic plans;
reporting the findings, opinions or recommendations in writing to other health care team members regarding this evaluation and future planning.
The start/stop time of the service must be documented in the patient’s medical record.
A statement of the medical condition and how it limits the patient’s ability to participate in the assessment must be documented.
A copy of the letter to other health care team members must be maintained in the patient’s medical record.
Failure to meet documentation requirements (start/stop times, medical condition statement, or copy of letter) will result in the fee being reduced to a lesser fee.
Calculation of time excludes time devoted to any other separately billable service or procedure.
Calculation of time excludes non-patient-facing time (e.g., reviewing charts, imaging, or documentation).
Not eligible for virtual care (not listed in Appendix J).
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