A471 – 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 requires a full, relevant history and physical examination of one or more systems.
When to Use
- Bill A471 for a patient presenting with a new, undiagnosed neurological deficit requiring a detailed history and physical exam of the neurological system, as opposed to a standard A007 assessment.
- Use A471 when a patient with a known complex condition, such as a rare autoimmune disorder, requires a focused re-assessment of that specific system due to new, concerning symptoms, differentiating it from a general re-assessment code like A474.
- A471 is appropriate for a patient with a severe, unexplained cardiac arrhythmia requiring a thorough cardiac history and physical, where a standard cardiology consultation (A470) might not fully capture the complexity of the re-assessment.
Common Pitfalls
- Billing A471 for routine follow-up of stable chronic conditions like uncomplicated hypertension or diabetes, which should be billed using less complex assessment codes.
- Failing to submit a written report of findings, opinions, or recommendations to the patient's primary care physician will result in the fee being adjusted to a lesser assessment fee.
- Exceeding the limit of 4 per patient per physician per 12-month period for the combination of A471 and A473/A474 will lead to a reduced fee for subsequent claims.
Billing Tips
- Ensure the patient's condition is truly complex, obscure, or serious, necessitating a full, relevant history and physical of one or more systems, to justify the use of A471 over other assessment codes.
- When applicable, append the E078 Chronic disease assessment premium to A471 for eligible respiratory disease specialists seeing patients with documented chronic respiratory diseases in an office or out-patient clinic setting.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Assessment
Requires a full, relevant history and physical examination of one or more systems.
The physician must report findings, opinions, or recommendations in writing to the patient’s primary care physician.
If the usage limit of 4 per 12 months is exceeded, the fee will be adjusted to a lesser assessment fee.
A471 is intended for complex, obscure, or serious conditions; routine follow-up of uncomplicated COPD should be billed using other assessment codes.
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