U025 – Initial E-Assessment
OHIP Other Code — Dermatology (02) · Schedule of Benefits
Initial e-assessment is the first e-assessment performed by a particular specialist that is requested by the primary care physician or nurse practitioner for a specific patient and diagnosis where the specialist must review all relevant data provided by the primary care physician and provide a written opinion that includes a diagnosis and/or management advice to the primary care physician or nurse practitioner.
When to Use
- Use U025 for the first time you provide a formal written opinion to a referring physician regarding a new patient diagnosis via electronic means.
- Use this code when you review a patient's clinical data and provide management advice without requiring an in-person consultation or a synchronous virtual visit.
Common Pitfalls
- Billing U025 when a subsequent request for the same diagnosis occurs; these must be billed as U023, U026, or U021 instead.
- Failing to provide a formal written report to the referring provider, which is a mandatory requirement for the claim to be valid.
- Attempting to bill U025 in conjunction with a K025 or other consultation codes for the same patient encounter.
Billing Tips
- Ensure your electronic record clearly links the referring physician's name and the specific clinical question to the U025 claim to satisfy audit requirements.
Effective: April 1, 2025
Consultations and Visits
Dermatology (02)
Assessment
Virtual Care Services, Assessments
Patient's name and health number
Name of the primary care physician or nurse practitioner
Date of, and reason for, the request
Opinion, diagnosis, advice and/or recommendations of the specialist
The time and intensity of this service is the same as a regular consultation. The specialist may choose to return their opinion by phone, however, a written opinion must be provided electronically or by mail.
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