U026 – Follow-Up E-Assessment
OHIP Other Code — Dermatology (02) · Schedule of Benefits
A follow-up e-assessment is the limited e-assessment rendered for follow-up by the specialist who has previously rendered any insured service to the patient for the same diagnosis. The specialist must review all relevant information submitted and provide an opinion and/or management advice to the primary care physician or nurse practitioner. An e-assessment is an insured service that is provided by a physician (specialist) to a primary care physician or nurse practitioner electronically or by telephone in respect of an insured person (patient) where the patient is not seen by the specialist.
When to Use
- Use U026 when providing a follow-up management recommendation to a primary care provider for a patient you have previously assessed for the same dermatological condition.
- Use this code when the primary care provider requests an update on a treatment plan or medication adjustment for a patient who does not require an in-person visit.
Common Pitfalls
- Billing U026 for the discussion of results from tests you personally ordered, which is explicitly excluded by the Schedule of Benefits.
- Submitting U026 when a K-prefix time-based service has been billed for the same patient within the preceding 30 days, leading to automatic rejection.
- Attempting to bill U026 on the same day as an A025 or A027 for the same patient, which violates the restriction against concurrent assessment billing.
Billing Tips
- Ensure your documentation explicitly references the previous insured service provided to the patient for the same diagnosis to satisfy the 'follow-up' requirement.
- Be aware that billing a consultation or assessment within 60 days of a U026 will trigger a payment adjustment, downgrading the subsequent visit to a partial assessment.
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 the service is the same as a partial assessment.
The specialist may choose to return their opinion by phone.
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