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Q304
Q304 – Q304
OHIP Critical Care Code · Schedule of Benefits
When to Use
- Use Q304 for the initial assessment and management of a patient presenting with a new or acute exacerbation of a chronic condition that requires a comprehensive evaluation beyond a standard office visit.
- Apply this code when performing a focused consultation for a specific diagnostic problem that necessitates a detailed history and physical examination, provided it does not meet the criteria for a full specialist consultation (A005).
- Utilize Q304 for complex patient encounters where the time and cognitive effort exceed the scope of a standard A007 assessment.
Common Pitfalls
- Billing Q304 on the same day as a minor procedure or another major assessment code (e.g., A007) will trigger an automatic rejection for duplicate service.
- Failing to document the specific clinical complexity or the time spent can lead to audit recovery, as the Ministry expects a higher level of documentation than a routine visit.
- Using Q304 for routine follow-up visits that should be billed under standard A007 codes is a frequent cause of claim adjustments.
Billing Tips
- Ensure the clinical note clearly justifies the complexity of the encounter to support the higher fee compared to standard assessment codes.
- Verify that no other major assessment or consultation code has been submitted for the same patient on the same date of service to avoid billing conflicts.
Provider Fee$92.92
Effective: April 1, 2026
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