All codes
A463
A463 – Medical specific assessment - Infectious Disease
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A service rendered by an infectious disease specialist in a place other than a patient’s home, requiring a full history of the presenting complaint and a detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis, exclude disease, and/or assess function.
When to Use
- Use A463 for an initial, in-depth assessment of a patient presenting with a new, undiagnosed infectious disease requiring a detailed history and physical examination focused on the specific complaint.
- Bill A463 when a patient requires a comprehensive evaluation for a suspected tick-borne illness, including a thorough history of exposure and a targeted physical exam.
- This code is appropriate for the initial assessment of a patient with a complex skin infection requiring a detailed dermatological examination and history to determine the causative agent and appropriate treatment.
Common Pitfalls
- Billing A463 for a follow-up visit for a previously diagnosed condition; A464 (Medical specific re-assessment) or A461 (Complex medical specific re-assessment) would be more appropriate.
- Submitting A463 on the same day as another assessment code (e.g., A275, A468) by the same physician for the same patient, as this is not permitted.
- Exceeding the limit of one A463 per patient per physician per 12 months without a clearly documented, unrelated second diagnosis or a hospital admission context.
Billing Tips
- Ensure the documentation clearly supports a 'full history of the presenting complaint' and a 'detailed examination' specific to the infectious disease, differentiating it from a general assessment.
- Consider billing the E078 (Chronic disease assessment premium) in conjunction with A463 if the patient has a documented chronic disease and the assessment is performed in an office or hospital out-patient clinic setting.
Provider Fee$0.00
Specialist Fee$94.40
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Consultations and Visits
Code Classes
Assessment
Assessments in excess of the 12-month limits will be adjusted to a lesser assessment fee (e.g., partial assessment).
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