All codes
A603
A603 – Medical specific assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A medical specific assessment is a specialist service requiring a full history of the presenting complaint and a detailed examination of the affected systems to make a diagnosis, exclude disease, or assess function.
When to Use
- Use A603 for a new patient referral presenting with undiagnosed shortness of breath requiring a comprehensive cardiac history and physical examination to establish a diagnosis of congestive heart failure.
- Bill A603 when a patient with known rheumatoid arthritis requires a detailed rheumatological assessment to evaluate disease activity and plan management, distinct from a routine follow-up.
- A603 is appropriate for a patient with new-onset neurological symptoms, such as unilateral weakness, necessitating a thorough neurological history and examination to rule out stroke or other serious conditions.
Common Pitfalls
- Billing A603 for a patient seen for a simple follow-up of a previously diagnosed condition; A604 (Medical specific re-assessment) would be more appropriate in such cases.
- Submitting A603 when the patient encounter is primarily for medication management without a significant change in condition or need for a new diagnostic workup; this may be better billed as a regular visit.
- Failing to meet the documentation requirements for a 'detailed examination of the affected systems' can lead to claim rejection or audits, especially if the history is extensive but the physical exam findings are minimal.
Billing Tips
- Ensure the diagnostic code submitted accurately reflects the presenting complaint that necessitated the specific assessment; for example, use 428 for CHF if that was the reason for the A603.
- Remember that A603 is limited to one per patient per physician per 12 months, unless the second assessment is for a clearly different, unrelated diagnosis or a hospital admission assessment at least 90 days later.
Provider Fee$0.00
Specialist Fee$81.55
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Specialist Office/Out-patient Visit
Code Classes
Assessment
Full history of presenting complaint
Detailed examination of affected part(s), region(s), or system(s)
Direct physical encounter (unless virtual suffix A is used)
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