A643 – Specific Assessment - General Thoracic Surgery
OHIP General Listings Code — General Thoracic Surgery (64) · Schedule of Benefits
A specific assessment requires 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 A643 for a new patient presenting with a persistent cough and shortness of breath requiring a detailed thoracic system examination and history to rule out conditions like interstitial lung disease or malignancy.
- Use A643 when assessing a patient with a history of lung cancer who presents with new chest pain, necessitating a comprehensive review of their presenting complaint and a focused thoracic examination to evaluate for recurrence or new pathology.
- A643 is appropriate for a patient referred for evaluation of a suspicious pulmonary nodule found on imaging, where a full history and detailed examination are required to determine the next steps in management.
Common Pitfalls
- Billing A643 for a patient already seen for the same condition within the last 12 months without documenting a clearly different and unrelated diagnosis, leading to fee adjustment.
- Using A643 for routine follow-up assessments of stable thoracic conditions, which should instead be billed using codes like A645 (Consultation) or A646 (Repeat consultation).
- Submitting A643 for an in-patient assessment; C643 is the correct code for specific assessments of hospital in-patients.
Billing Tips
- Ensure your documentation clearly outlines the 'full history of the presenting complaint' and 'detailed examination of the affected part(s), region(s), or system(s)' to justify the specific assessment nature of A643.
- If a second A643 is billed within 12 months, explicitly state in the patient's chart that the second assessment is for a 'clearly different and unrelated diagnosis' to avoid payment adjustments.
Effective: June 1, 2025
Consultations and Visits
General Thoracic Surgery (64)
Consultations and Visits
Assessment
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.
A643A is eligible for virtual care (video) as per Appendix J.
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