A414 – Medical Specific Re-Assessment
OHIP General Listings Code — Gastroenterology (41) · Schedule of Benefits
A medical specific re-assessment is a service rendered by a specialist requiring a full, relevant history and physical examination of one or more systems.
When to Use
- Use A414 for a specialist's follow-up visit to re-evaluate a patient's inflammatory bowel disease (e.g., Crohn's or ulcerative colitis) after initial investigations, requiring a focused history and physical exam of the GI system.
- Bill A414 when a specialist performs a detailed re-assessment of a patient with chronic liver cirrhosis, including a relevant history and physical, to monitor disease progression or treatment response.
- A414 is appropriate for a specialist re-assessment of a patient with celiac disease who is experiencing persistent symptoms despite adherence to a gluten-free diet, necessitating a thorough GI system review.
Common Pitfalls
- Billing A414 more than twice per patient per physician within a 12-month period without a hospital admission will result in payment adjustment to a lesser assessment fee.
- Submitting A414 with a diagnosis code other than the required 263, 555, 556, 571, or 579 will lead to claim rejection.
- Using A414 for a patient already admitted to hospital for the same illness by the same physician may be more appropriately billed as C414 (Medical specific re-assessment - Hospital In-patient).
Billing Tips
- Ensure the documentation clearly supports a 'full, relevant history and physical examination of one or more systems' to justify the A414 service.
- A414 is eligible for the E098 Gastroenterology chronic disease assessment premium when provided in an office or hospital outpatient setting for specific chronic conditions like Crohn's disease or ulcerative colitis.
Effective: June 1, 2025
Consultations and Visits
Gastroenterology (41)
Consultations and Visits
Assessment
Requires a full, relevant history and physical examination of one or more systems.
Admission assessments are deemed to be a specific re-assessment or medical specific re-assessment under either of the following circumstances: for those procedures prefixed with a “Z” or noted as an IOP, by a surgical specialist who has assessed the patient prior to admission in respect of the same illness; or for those patients who have been assessed by a physician and subsequently admitted to the hospital for the same illness by the same physician.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.