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V402
V402 – V402
OHIP Other Code · Schedule of Benefits
When to Use
- Use V402 for the initial assessment of a patient presenting with a specific minor illness or injury that does not require the comprehensive evaluation of an A007.
- Apply this code for a focused, single-issue follow-up visit where the complexity does not meet the threshold for a minor assessment (A001) or intermediate assessment (A007).
- Utilize V402 for brief, non-procedural encounters where the physician provides a limited assessment and advice for a stable, chronic condition.
Common Pitfalls
- Billing V402 on the same day as a major assessment code like A007 or A008 for the same patient will result in a rejection for duplicate service.
- Using V402 for visits that involve significant counseling or complex decision-making is an audit risk, as these scenarios require higher-valued assessment codes.
- Failing to include a diagnostic code that justifies a visit, even for a minor assessment, will lead to automatic claim rejection.
Billing Tips
- Ensure the clinical note clearly reflects a focused encounter to support the use of V402 over higher-paying assessment codes during OHIP audits.
- If a procedure is performed during the same visit, ensure the procedure code is billed in addition to V402, provided the assessment was distinct and necessary.
Provider Fee$25.15
Effective: September 1, 2023
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