A474 – Respiratory disease - medical specific re-assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A medical specific re-assessment rendered by a specialist in Respiratory Disease (47), requiring a full, relevant history and physical examination of one or more systems.
When to Use
- Bill A474 for a specialist in Respiratory Disease following up on a patient previously assessed for COPD, where a new exacerbation requires a detailed history and a focused physical exam of the respiratory system.
- Use A474 when a patient with a known interstitial lung disease, previously assessed by a respiratory specialist, presents with new symptoms requiring a full history and physical examination of the respiratory and cardiovascular systems.
- A474 is appropriate for a respiratory specialist re-assessing a patient post-pneumonia treatment, requiring a comprehensive history of recovery and a physical exam of the chest and vital signs.
Common Pitfalls
- Billing A474 when the patient has not been previously assessed by the physician for the same condition; A473 (Medical specific assessment) is the correct code for the initial assessment.
- Exceeding the limit of two A474 claims per patient per physician within a 12-month period without meeting the exception for hospital admissions, leading to a fee adjustment.
- Submitting A474 for a brief follow-up or a minor change in management that does not involve a full, relevant history and physical examination; consider A478 (Partial assessment) in such cases.
Billing Tips
- Ensure the documentation clearly outlines the specific respiratory condition being re-assessed and details the full, relevant history and physical examination performed, differentiating it from a partial assessment (A478).
- When a patient is admitted to hospital, and you have assessed them prior to admission for the same illness or admit them after assessment, this qualifies as a medical-specific re-assessment and can be billed as A474, even if it exceeds the usual limit.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Specialist Assessment
Assessment
Requires a full, relevant history.
Requires a physical examination of one or more systems.
If the limit of two per 12 months is exceeded, the fee is adjusted to a lesser assessment fee (typically a partial assessment).
Admission assessments are deemed to be a medical specific re-assessment if the physician has assessed the patient prior to admission for the same illness or admits the patient after assessment.
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