U235 – Initial E-Assessment
OHIP Other Code — Ophthalmology (23) · 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. [Commentary: 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. Source: :]
When to Use
- Use U235 when a primary care provider requests a formal specialist opinion on a new clinical issue that can be managed through a comprehensive review of records and diagnostic data without a physical examination.
- Select U235 for the first-time electronic review of a patient's chart and diagnostic imaging for a specific diagnosis, provided the specialist issues a formal written report back to the referring provider.
Common Pitfalls
- Submitting U235 for a patient you have already seen or consulted on for the same diagnosis, which should instead be billed as U233, U236, or U231.
- Failing to include the referring physician or nurse practitioner's billing number on the claim, which will result in an automatic rejection.
- Billing U235 when the service is merely a brief phone call or informal advice, as it requires a formal written opinion and comprehensive data review equivalent to a full consultation.
Billing Tips
- Ensure the referring provider's billing number is captured in the 'Referring Physician' field of your billing software to satisfy the mandatory submission requirement for U235.
Effective: April 1, 2025
Consultations and Visits
Ophthalmology (23)
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:
- 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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