All codes
A468
A468 – Partial assessment - infectious disease
OHIP General Listings Code — CONSULTATIONS AND VISITS · 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 A468 for follow-up infectious disease assessments where the patient's condition has stabilized, and a full A463 or A270 is not warranted.
- Use A468 for reviewing uncomplicated infectious disease test results and providing subsequent management advice.
- Appropriate for initial management of a new, straightforward infectious disease presentation that does not require a comprehensive assessment (A460).
Common Pitfalls
- Billing A468 when a more comprehensive assessment like A463 or A270 is clinically indicated, leading to potential under-billing.
- Claiming A468 on the same day as another assessment or consultation (e.g., A465, A275) by the same physician without meeting specific criteria for separate services.
- Failure to document the specific elements of the partial assessment (history, exam, advice, record) in the patient's chart, which is a requirement for A468.
Billing Tips
- A468 can be billed with the K001 (Detention) premium if the service exceeds 30 minutes, provided the documentation supports the extended time.
- Consider the E078 (Chronic disease assessment premium) if the patient has a documented chronic disease relevant to the infectious disease being managed.
Provider Fee$0.00
Specialist Fee$45.00
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Consultations and Visits
Code Classes
Assessment
A465ConsultationA460Comprehensive infectious disease consultationA270Complex infectious disease assessmentA463Medical specific assessmentE078Chronic disease assessment premiumA275Limited consultationA466Repeat consultationA464Medical specific re-assessmentA461Complex medical specific re-assessmentA468Partial assessment
The start and stop times should be recorded in the patient's permanent medical record as per the section requirements on page A125.
Eligible for Special Visit Premiums if the visit is non-elective and meets -78 criteria.
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