A713 – Medical Specific Assessment
OHIP General Listings Code — Critical Care Medicine (11) · Schedule of Benefits
A medical specific assessment is a service rendered by a specialist in a place other than a patient’s home. It requires a full history of the presenting complaint and a 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
- Use A713 for a specialist's initial assessment of a patient presenting with a new, specific complaint in their office, distinct from a referral-based consultation (A715).
- Bill A713 when a specialist performs a focused history and physical examination to diagnose or rule out a specific condition, even without a formal referral.
- A713 is appropriate for an assessment in a place other than a patient's home, differentiating it from home visit codes.
Common Pitfalls
- Billing A713 for a service that meets the criteria for a consultation (A715) or a repeat consultation (A116) can lead to claim rejection.
- Exceeding the limit of 4 combined A713 and A111 claims per patient per physician per 12 months will result in claims being denied.
- Using A713 for an in-patient assessment is incorrect; C713 must be used for hospital in-patients.
Billing Tips
- Ensure documentation clearly details the specific presenting complaint, focused history, and targeted examination supporting the diagnosis or exclusion of disease.
- Remember that A713A is the virtual care equivalent and should be used for telehealth assessments meeting the same criteria.
Effective: June 1, 2025
Consultations and Visits
Critical Care Medicine (11)
Consultations and Visits
Assessment
Full history of the presenting complaint.
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.
Includes all specific elements of assessments as defined in (direct physical encounter, inquiry, making arrangements for follow-up, etc.).
Listed under Critical Care Medicine (11) General Listings.
If rendered in the Emergency or Out-patient Department (OPD) by a physician not on duty, use this General Listing code.
A713A is the virtual care version of this service.
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