All codes
Q313
Q313 – Q313
OHIP Critical Care Code · Schedule of Benefits
When to Use
- Use Q313 as the primary code for the initial assessment of a patient presenting with a minor illness or injury that does not meet the complexity requirements of an A007 or A003.
- Apply Q313 when providing a brief, focused consultation for a specific complaint that is resolved within a single encounter, provided no other major assessment code is claimed.
Common Pitfalls
- Claiming Q313 in conjunction with a major assessment code like A007 or A003 for the same patient on the same day will result in an automatic rejection.
- Using Q313 for chronic disease management or complex follow-ups where a higher-valued assessment code is clinically justified and more appropriate for the time spent.
Billing Tips
- Ensure the clinical documentation clearly supports a minor assessment to defend against potential post-payment audits that flag Q313 usage for complex cases.
Provider Fee$20.00
Effective: April 1, 2026
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