A613 – Medical Specific Assessment
OHIP General Listings Code — Haematology (61) · Schedule of Benefits
A service rendered by a specialist in Haematology, in a place other than a patient’s home, requiring a full history of the presenting complaint and detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis, and/or exclude disease, and/or assess function.
When to Use
- Bill A613 for a new patient presenting with undiagnosed bleeding disorders requiring a comprehensive history and physical examination to establish a diagnosis.
- Use A613 when a specialist in Haematology performs a detailed assessment for a patient with a suspected or existing complex thrombotic disorder, distinct from a routine follow-up.
- A613 is appropriate for an initial assessment of a patient with a newly diagnosed or suspected lymphoproliferative disorder, necessitating a thorough diagnostic workup.
Common Pitfalls
- Billing A613 for a patient already assessed by the same physician for the same condition within the last 12 months, unless specific criteria for a second assessment are met.
- Submitting A613 for a patient who is an in-patient in a hospital, as C613 is the correct code for hospital in-patient medical specific assessments.
- Using A613 when the service is primarily a follow-up or re-assessment; A614 (Medical specific re-assessment) or A611 (Complex medical specific re-assessment) would be more appropriate.
Billing Tips
- Ensure documentation clearly supports a 'medical specific assessment' by detailing the history, examination, and diagnostic reasoning, differentiating it from a general consultation (A615) or partial assessment (A618).
- A613 can be eligible for the Chronic Disease Assessment Premium (E078) if the patient has an established chronic disease, the assessment occurs in an office or out-patient clinic setting (not a hospital in-patient or ER), and other criteria are met.
Effective: June 1, 2025
Consultations and Visits
Haematology (61)
Specialist Assessment
Assessment
Full history of the presenting complaint.
Detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis, exclude disease, and/or assess function.
Service must be rendered in a place other than the patient’s home.
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