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A478
A478 – Partial assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A partial assessment is a limited service that constitutes a history of the presenting complaint, the necessary physical examination, advice to the patient, and an appropriate record. In the context of Respiratory Disease, it is intended for the evaluation and/or management of uncomplicated respiratory disorders, such as routine follow-up of uncomplicated chronic obstructive pulmonary disease (e.g., emphysema, chronic bronchitis).
When to Use
- Bill A478 for a routine follow-up of a stable COPD patient who has had their A570 visit limit reached.
- Use A478 when a patient's A473 or A474 visit exceeds the frequency limit, and the service is a limited assessment of a respiratory condition.
- Claim A478 for a brief assessment of a new, uncomplicated respiratory complaint that does not warrant a full medical-specific assessment (A473).
Common Pitfalls
- Billing A478 for a patient encounter that meets the criteria for a more specific assessment code (e.g., A473) when frequency limits have not been exceeded.
- Claiming A478 for a complex respiratory issue; these situations may be better suited for A570 if criteria are met, or may require more detailed documentation if billed as a different assessment.
- Not recognizing that A478 is a fallback code; if a more specific respiratory assessment code (A473, A474, A570) is used beyond its frequency limit, OHIP will automatically adjust it to A478.
Billing Tips
- Ensure the documentation clearly reflects a limited history, focused examination, and advice, distinguishing it from a comprehensive assessment.
- A478 can be billed with the E078 premium if the patient has a documented chronic respiratory disease and meets all other E078 criteria.
Provider Fee$0.00
Specialist Fee$39.60
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Office/Out-patient
Code Classes
Assessment
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