U021 – Complex psoriasis or complex dermatitis
OHIP Other Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A minor e-assessment is a brief e-assessment rendered by the specialist. The specialist must review all relevant information submitted and provide an answer to the primary care physician's or nurse practitioner's specific clinical question.
When to Use
- Use U021 when a primary care provider requests a brief, targeted adjustment to a treatment plan already established by your office, such as modifying a topical steroid regimen for complex psoriasis.
- Use U021 for a focused clinical question regarding a patient with complex dermatitis where the review of provided information and your subsequent advice requires minimal time compared to a full consultation (A005) or a major e-assessment (U025).
Common Pitfalls
- Billing U021 for a request that requires a comprehensive review of a new patient's history, which should instead be billed as a major e-assessment (U025) or a formal consultation (A005).
- Submitting U021 for multiple exchanges that constitute a full consultation; if the complexity exceeds a 'minor' assessment, you must use the appropriate higher-value code to avoid audit flags for under-coding or misrepresentation.
- Failing to document the specific clinical question from the referring provider, which is a mandatory requirement for U021 and a common trigger for claim rejection.
Billing Tips
- Ensure your documentation explicitly links the advice provided to the specific question asked by the referring provider to satisfy the 'minor e-assessment' criteria and distinguish it from a routine follow-up.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Virtual Care Services, Assessments
An e-assessment is only eligible for payment if all of the following elements are included in the patient's permanent medical record of the specialist:
1. patient's name and health number;
2. name of the primary care physician or nurse practitioner;
3. date of, and reason for, the request; and
4. opinion, diagnosis, advice and/or recommendations of the specialist.
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