All codes
A418
A418 – Partial Assessment
OHIP General Listings Code — Gastroenterology (41) · 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 A418 for a focused history and physical examination of a new gastrointestinal complaint, such as acute abdominal pain, where a full consultation (A415) is not warranted.
- Use A418 when a patient presents with a specific gastrointestinal symptom requiring a brief assessment, examination, and immediate management plan, but not a comprehensive workup.
- A418 is appropriate for follow-up visits where the patient's presenting complaint has evolved, requiring a targeted reassessment and adjustment of the management plan.
Common Pitfalls
- Billing A418 when the service provided was a general medical assessment (e.g., A007) or a full consultation (A415), as A418 is specifically for a *partial* assessment.
- Submitting A418 on the same day as a colonoscopy (A120) without meeting the specific criteria for the A120 assessment, which can lead to claim rejection.
- Failing to document the specific presenting complaint, the limited examination performed, and the advice given, which are the core components of a partial assessment.
Billing Tips
- Ensure the diagnostic code submitted with A418 aligns with the specific gastrointestinal complaint addressed, such as 263 (Peptic Ulcer), 555 (Irritable Bowel Syndrome), or 571 (Diverticulitis).
- A418 is eligible for the Gastroenterology chronic disease assessment premium (E098) if the patient has a documented diagnosis of Crohn's disease, Ulcerative Colitis, malnutrition, Celiac disease, or chronic liver cirrhosis and the service is provided in an office or outpatient clinic setting.
Provider Fee$0.00
Specialist Fee$38.05
Effective: June 1, 2025
Category
Consultations and Visits
Subcategory
Gastroenterology (41)
Service Type
Consultations and Visits
Code Classes
Assessment
A418 is the Gastroenterology-specific partial assessment code.
For services not listed in the Gastroenterology section, refer to the Internal Medicine section.
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