A262 – Level 2 - Paediatric assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A Level 2 paediatric assessment is a paediatric service that requires a more extensive examination than a level 1 paediatric assessment. It requires a history of the presenting complaint(s), inquiry concerning, and examination of the affected part(s), region(s), system(s), or mental or emotional disorder as needed to make a diagnosis, exclude disease, and/or assess function. It also includes well baby care, which is a periodic assessment of a well newborn / infant during the first two years of life including complete examination with weight and measurements, and instructions to the parent(s) or patient’s representative regarding health care.
When to Use
- Bill A262 for a well-baby check in a child under two years, including weight, measurements, and parental counselling, which is more comprehensive than a Level 1 assessment (A261).
- Use A262 when a child under two presents with a specific acute complaint requiring a detailed history and examination of the affected system, exceeding the scope of a simple visit code.
- A262 is appropriate for a specialist paediatrician performing a focused assessment on a child with a new, complex presenting problem requiring a more in-depth workup than a general assessment.
Common Pitfalls
- Billing A262 for a routine periodic health visit for a child over two years; use K267 or K269 instead.
- Submitting A262 when the service provided was a simple follow-up or minor acute issue that did not warrant an extensive history and examination, potentially leading to claims review.
- Failing to document the specific components of a well-baby assessment (weight, measurements, parental counselling) when billing A262 for this purpose.
Billing Tips
- A262 can be billed in conjunction with the Chronic Disease Assessment Premium (E078) if the child has a documented chronic condition requiring assessment.
- For virtual A262 services, remember to append the 'A' suffix to the billing code.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Assessment
Requires a history of the presenting complaint(s).
Requires inquiry concerning and examination of the affected part(s), region(s), system(s), or mental/emotional disorder.
For well baby care: includes complete examination with weight and measurements, and instructions to parents/representatives.
first two years of life
A262 is considered a 'Level 2' assessment, which is more extensive than a 'Level 1' (A261).
A262 can be used as the assessment component of a Periodic Health Visit (K267, K269).
Unless otherwise specified in the Schedule, the calculation of time for A260, A262 and A667 excludes (1) time devoted to any other service or procedure for which an amount is payable in addition to the consultation and (2) non-patient-facing time such as such as time spent reviewing charts, imaging, or documentation, etc.
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