A252 – Ophthalmology consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Initial vision rehabilitation assessment by an ophthalmologist of a patient with either low visual acuity, visual field defect, or significant oculomotor dysfunction, requiring a minimum of four specific rehabilitation components.
When to Use
- Bill A252 for a patient with significant visual field loss due to optic nerve damage, where you are assessing their ability to read using specialized charts and prescribing adaptive devices.
- Use A252 when a patient with advanced macular degeneration has best corrected visual acuity of 20/100 in both eyes and requires a comprehensive assessment of their residual vision, including contrast sensitivity testing and a formal vision rehabilitation plan.
- A252 is appropriate for a patient with nystagmus causing low visual acuity and oculomotor dysfunction, where you are evaluating their cognitive function in relation to visual tasks and initiating supervised training.
Common Pitfalls
- Claims for A252 will be adjusted to a lesser assessment fee if fewer than four of the eight specified rehabilitation components are documented, even if the patient meets the acuity or field defect criteria.
- Billing A252 on the same day as another consultation or assessment (e.g., A233, A234) by the same physician will result in the A252 claim being ineligible for payment.
- Submitting A252 for patients whose visual impairment is amenable to further medical or surgical treatment, such as cataract surgery or treatment for diabetic retinopathy, will lead to claim rejection.
Billing Tips
- Ensure your documentation clearly lists which of the eight required components were performed, noting at least four must be present for A252 to be valid.
- Diagnostic procedures like visual field testing (e.g., A157) are separately billable alongside A252, provided they are not part of the core assessment components already accounted for.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Ophthalmology
Assessment
Minimum of 4 of 8 components must be rendered: 1. Cognitive assessment; 2. Residual visual function (2+ tests); 3. Eccentric preferred retinal loci; 4. Near functional acuity; 5. Reading skills; 6. Prescribing low vision devices; 7. Vision rehab plan; 8. Supervised training.
A252 is a specialized vision rehabilitation service, not a standard consultation.
Diagnostic procedures are an exception to the general inclusion rule and are separately billable.
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