A464 – Infectious Disease - Medical specific re-assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A medical specific re-assessment is a service rendered by a specialist that requires a full, relevant history and physical examination of one or more systems.
When to Use
- Bill A464 when a specialist performs a comprehensive re-assessment of a patient with a new or significantly changed infectious disease presentation, requiring a detailed history and physical exam of relevant systems.
- Use A464 for a follow-up specialist visit where a patient's infectious disease has progressed or responded unexpectedly, necessitating a repeat full history and physical to adjust management.
- A464 is appropriate when a specialist re-evaluates a patient previously seen for an infectious disease, and the current presentation requires a new, in-depth history and physical examination of affected systems, distinct from a simple follow-up or partial assessment (A468).
Common Pitfalls
- Billing A464 for a routine follow-up visit that does not involve a full, relevant history and physical examination of one or more systems can lead to claim rejection or adjustment.
- Exceeding the limit of two A464 claims per patient per physician within a 12-month period, without meeting the hospital admission exception, will result in the claim being paid at a lesser assessment fee.
- Failure to record start and stop times for the service in the patient's medical record can lead to the payable amount being adjusted to a lesser fee.
Billing Tips
- A464 can be billed in conjunction with E078 if the patient has a documented chronic disease and meets all other criteria for the Chronic Disease Assessment Premium.
- Ensure the documentation clearly distinguishes the re-assessment from a standard follow-up visit by detailing the specific history obtained and the physical examination performed on the relevant systems.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Medical specific re-assessment
Assessment
The start and stop times must be recorded in the patient’s permanent medical record or the amount payable for the service will be adjusted to a lesser paying fee.
Requires a full, relevant history and physical examination of one or more systems.
Must include all constituent and common elements of an assessment as defined in the General Preamble.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.