A484 – Complex rheumatology assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A medical specific re-assessment is a service rendered by a specialist in rheumatology that requires a full, relevant history and physical examination of one or more systems.
When to Use
- Bill A484 for a patient with newly diagnosed rheumatoid arthritis requiring a detailed history and physical exam to establish a management plan, distinct from an initial assessment (A483).
- Use A484 when re-evaluating a patient with a complex autoimmune condition like lupus, where a comprehensive review of multiple organ systems and a detailed physical exam are necessary.
- A484 is appropriate for a patient with polymyalgia rheumatica experiencing new symptoms, necessitating a focused history and physical to assess disease activity and adjust treatment.
Common Pitfalls
- Billing A484 for uncomplicated conditions like osteoarthritis or simple bursitis, which are better suited for A483 or other assessment codes.
- Submitting A484 more than twice per patient per physician within a 12-month period, unless for hospital admissions, risking payment adjustment.
- Billing A484 on the same day as another assessment or consultation (e.g., A483, A481) by the same physician for the same patient, as it is not payable.
Billing Tips
- Ensure the patient's medical record clearly documents a full, relevant history and a physical examination of one or more systems to support the A484 claim.
- Consider billing the Chronic Disease Assessment Premium (E078) with A484 for eligible patients with a documented chronic rheumatologic condition, provided the assessment occurs in an office or out-patient clinic setting.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Assessment
A484 is the Rheumatology-specific version of the medical specific re-assessment (equivalent to A134 in Internal Medicine).
The Chronic Disease Assessment Premium (E078) is commonly billed with this code for patients with chronic rheumatologic conditions.
While the code A484 is listed as 'Medical specific re-assessment' in the primary Rheumatology table (A199), it is often associated with the 'Complex rheumatology assessment' commentary on page A200 which describes the management of complex musculoskeletal disorders.
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