All codes
A461
A461 – 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. It includes all the requirements of a medical specific re-assessment, which requires a full, relevant history and physical examination of one or more systems.
When to Use
- Billing for a follow-up visit for a patient with a severe, undiagnosed autoimmune condition requiring extensive history and physical examination, and a written report to the PCP.
- Using this code for a patient with a complex, multi-system infection that has not responded to initial treatment, necessitating a detailed re-evaluation and consultation report.
- Billing for a patient with a rare neurological disorder that has recently worsened, requiring a thorough reassessment of multiple neurological systems and a report to the referring physician.
Common Pitfalls
- Billing A461 when the patient's condition is not complex or serious enough, leading to claims being adjusted to a lesser assessment fee.
- Failing to document the start and stop times of the assessment in the patient's medical record, which can result in a reduced fee.
- Not providing a written report of findings, opinions, or recommendations to the patient's primary care physician, which is a mandatory requirement for this code.
Billing Tips
- Ensure the patient's condition truly warrants the complexity of A461; if it's a straightforward re-assessment, consider A464 instead.
- Remember that A461 shares a usage limit of 4 per patient per 12 months with A463, so track these services carefully to avoid exceeding the limit.
Provider Fee$0.00
Specialist Fee$83.85
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Consultations and Visits
Code Classes
Assessment
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