All codes
A354
A354 – Partial Assessment
OHIP General Listings Code — Urology (35) · 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.
When to Use
- Bill A354 for a patient presenting with a new, isolated urinary complaint (e.g., dysuria, mild hematuria) requiring a focused history, exam, and advice, without needing a full consultation (A355).
- Use A354 when a patient requires a brief urological assessment for a specific, non-complex issue, such as evaluating a new onset of urinary frequency, where a full consultation is not warranted.
- A354 is appropriate for follow-up of a resolved issue where a new, limited assessment is needed, distinct from a repeat consultation (A356) or a specific assessment (A353).
Common Pitfalls
- Avoid billing A354 if the service involves a more complex workup or management plan that would qualify for a consultation (A355) or a specific assessment (A353).
- Do not bill A354 if another physician has already billed an assessment or consultation for the same patient on the same day, as per the same-day restrictions.
- Ensure the service includes a history, physical exam, advice, and record-keeping; billing A354 without these components may lead to audits or rejections.
Billing Tips
- For virtual care, append the 'A' suffix to A354 and confirm the service meets the 'Comprehensive Virtual Care' requirements, including appropriate documentation of the virtual encounter.
- While A354 includes limited procedures like catheterization, it does not cover endoscopic examinations; ensure the procedure performed aligns with the code's scope to avoid billing discrepancies.
Provider Fee$0.00
Specialist Fee$27.80
Effective: June 1, 2025
Category
Consultations and Visits
Subcategory
Urology (35)
Service Type
Consultations and Visits
Code Classes
Assessment
May include physical examination pertaining to the genito-urinary tract and when necessary such procedures as urethral calibration, catheterization and prostatic fluid examination, but not to include endoscopic examination.
Chronic Disease Assessment Premium is not applicable to Urology.
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