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A633
A633 – Specific Assessment
OHIP General Listings Code — Nuclear Medicine (63) · Schedule of Benefits
A specialist assessment 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
- When a nuclear medicine specialist performs a full history and detailed examination of a patient presenting with new symptoms requiring a diagnosis, such as evaluating a patient with new onset chest pain for potential myocardial perfusion imaging.
- To bill for a comprehensive assessment of a patient's condition related to a nuclear medicine procedure, including a detailed history of the presenting complaint and examination of the relevant system, for example, assessing a patient with suspected pulmonary embolism prior to a V/Q scan.
- When a specialist requires a thorough workup beyond a simple history and physical to determine the appropriate nuclear medicine study or to interpret complex findings, such as evaluating a patient with a history of thyroid cancer for recurrence with a whole-body iodine scan.
Common Pitfalls
- Billing A633 for a follow-up visit that does not involve a new, distinct assessment; use A636 (Repeat consultation) for routine follow-ups.
- Submitting A633 more than once per patient per 12 months without a clearly documented, unrelated new diagnosis; the second claim will be reduced.
- Using A633 when a less comprehensive assessment is sufficient; A631 (Minor assessment) or A638 (Partial assessment) may be more appropriate if the history and examination are not as extensive.
Billing Tips
- Ensure the documentation clearly supports a 'full history of the presenting complaint' and a 'detailed examination of the affected part(s), region(s), or system(s)' to justify the A633 code.
- If the second A633 visit is for a different, unrelated diagnosis, explicitly state this in the patient's chart and on the claim to avoid adjustment.
Provider Fee$0.00
Specialist Fee$60.00
Effective: June 1, 2025
Category
Consultations and Visits
Subcategory
Nuclear Medicine (63)
Service Type
Specialist Assessment
Code Classes
Assessment
A633 is specifically listed under the Nuclear Medicine section of the Schedule.
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