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U231
U231 – Minor E-Assessment
OHIP Other Code — Ophthalmology (23) · 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 U231 when providing a brief, targeted response to a specific clinical query from a referring provider, such as adjusting a medication dosage for an existing patient.
- Select U231 for quick clarifications on diagnostic test results or imaging that do not require the comprehensive review associated with a full consultation code like A025.
Common Pitfalls
- Submitting U231 without the referring physician's or nurse practitioner's billing number will result in an automatic rejection.
- Billing U231 for a service that evolves into a formal consultation; if the complexity exceeds a 'minor' assessment, you must use the appropriate consultation code instead.
- Attempting to bill U231 on the same day as a formal consultation or office visit for the same patient, which violates the single-service-per-day restriction.
Billing Tips
- Ensure your documentation explicitly links the specialist's advice to the specific question posed by the referring provider to satisfy audit requirements for a 'minor' assessment.
- If the clinical inquiry requires a more extensive review of the patient's history and records, bill U233 (Intermediate E-Assessment) instead to reflect the higher complexity and time commitment.
Provider Fee$0.00
Specialist Fee$15.00
Effective: April 1, 2025
Category
Consultations and Visits
Subcategory
Ophthalmology (23)
Service Type
Assessment
Code Classes
Virtual Care Services, Assessments
Referral RequiredFrom: Physician, NursePractitioner
patient's name and health number;
name of the primary care physician or nurse practitioner;
date of, and reason for, the request; and
opinion, diagnosis, advice and/or recommendations of the specialist.
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