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A311
A311 – Complex medical specific re-assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A complex medical specific re-assessment is a re-assessment of a patient because of the complexity, obscurity, or seriousness of the patient’s condition and includes all the requirements of a medical specific re-assessment (a full, relevant history and physical examination of one or more systems).
When to Use
- Bill A311 when a patient presents with a newly diagnosed, complex neurological condition requiring a detailed history and physical examination of the neurological system, and a written report is sent to the primary care physician.
- Use A311 for a patient with a severe, undiagnosed autoimmune disorder where a comprehensive review of multiple organ systems is necessary, and the findings are communicated in writing to the referring physician.
- A311 is appropriate for a patient with a rapidly progressing, rare malignancy requiring a thorough assessment of their overall status and specific disease impact, with a detailed report provided to the primary care physician.
Common Pitfalls
- Billing A311 when the patient's condition is not complex, obscure, or serious; this may lead to claims being adjusted to a lesser assessment fee like A310.
- Failing to submit a written report of findings, opinions, or recommendations to the patient's primary care physician will result in the fee being adjusted to a lesser assessment fee.
- Exceeding the limit of 4 per patient per physician per 12-month period for A311, which is shared with A313, can lead to claims being denied or adjusted.
Billing Tips
- Ensure the written report to the primary care physician is comprehensive, detailing the complexity of the condition and the physician's assessment and recommendations.
- A311 can be billed with the E078 Chronic disease assessment premium if the patient has a documented chronic disease and meets all other E078 criteria.
Provider Fee$0.00
Specialist Fee$73.95
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Consultations and Visits
Code Classes
Assessment
The physician must report findings, opinions, or recommendations in writing to the patient’s primary care physician.
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