A628 – Partial Assessment
OHIP General Listings Code — Clinical Immunology (62) · Schedule of Benefits
A partial assessment is the limited service that constitutes a history of the presenting complaint, the necessary physical examination, advice to the patient and appropriate record.
When to Use
- Bill A628 for a focused follow-up visit where a patient with a known autoimmune condition requires a brief assessment of a new, but related, symptom, such as a mild rash flare.
- Use A628 when a patient presents for a short, specific consultation regarding a new immunological concern, like a reaction to a vaccination, and requires a brief examination and advice.
- A628 is appropriate for a quick review of recent lab results for an established immunology patient, provided it includes a brief physical check and discussion of findings.
Common Pitfalls
- Billing A628 when a more comprehensive assessment (e.g., A623) is warranted due to the complexity or duration of the presenting complaint.
- Submitting A628 for a routine follow-up of a stable chronic condition that does not involve a new complaint or significant change in management.
- Using A628 when the patient is an inpatient; C628 is the appropriate code for concurrent care in that setting.
Billing Tips
- Ensure the documentation clearly outlines the 'presenting complaint' and the specific 'physical examination' performed, however limited, to justify the A628 service.
- When managing a patient with a documented chronic immunological disease, consider if the E078 Chronic Disease Assessment Premium is applicable to this A628 visit for additional reimbursement.
Effective: June 1, 2025
Consultations and Visits
Clinical Immunology (62)
Clinical Immunology
Assessment
History of the presenting complaint.
Necessary physical examination.
Advice to the patient.
Appropriate medical record.
For services not listed under Clinical Immunology, physicians should refer to the Internal Medicine section.
If the physician is in the hospital but not on duty in the Emergency Department, the General Listings (A-prefix) apply for patients seen in the ED or OPD.
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