A114 OHIP Billing Code: Re-assessment Details

1What Is the A114 OHIP Code?

What is A114?

A114 is an OHIP billing code for a medical specific re-assessment offered by specialists in critical care. This service involves a detailed re-evaluation of a patient’s condition with respect to specific ongoing issues like tracheostomy weaning or persistent dyspnoea. The re-assessment is focused on particular problems and not a comprehensive review of the patient's complete critical illness history.

Clinicians commonly miss billing this code when they fail to differentiate between a specific re-assessment and a full assessment. Additionally, incomplete documentation of the assessment duration can lead to billings being disallowed.

2Related Codes

Code	Name	Frequency	Description
A713	A713 Medical specific assessment	Unlimited; re-assessment limitations apply	General medical specific assessments in critical care.
C713	C713 Medical specific assessment	Unlimited; hospital in-patient usage	Hospital in-patient equivalent code for medical specific assessment.
A111	A111 Complex medical specific re-assessment	Conditions similar to A114 but for more complex cases	Used for more comprehensive evaluations compared to A114.
C111	C111 Complex medical specific re-assessment	Hospital in-patient usage for complex conditions	Hospital in-patient equivalent for complex re-assessment.

3Eligibility Requirements

Eligibility Requirements

Per the OHIP Schedule of Benefits:

Physician Role: The service is rendered by specialists in critical care.
Assessment Requirement: It requires a full, relevant history and a physical examination of one or more systems.
Billing Frequency: Limited to two per patient per physician per 12-month period, except when associated with hospital admissions.
Documentation: Time of service start and end must be recorded in the patient's medical record.
Virtual Delivery: This service can also be provided virtually and billed as A114A via video or telephone.

4What Your Clinical Note Must Show

1Time Recording

Physicians must accurately record service start and end times.

Ensure start and end times of the assessment are documented in the patient's record.
Include precise date alongside the time records.

5Weak vs. Strong Note Examples

The strong note succeeds due to specific documentation of clinical actions, times, and a clear follow-up plan, while the weak note lacks sufficient detail.

❌ Weak Note

Re-assessment completed. Follow-up in two weeks.

✓ Strong Note

Re-assessment conducted for tracheostomy weaning issues. Complete respiratory and cardiovascular exams performed.

Exam start: 10:00 AM
Exam end: 10:40 AM
Plan: Continue current weaning schedule, additional follow-up needed in one week with potential escalation if dyspnoea persists.

6Common Reasons This Code Is Missed

Incomplete Documentation

Lack of recorded start and end times can void the claim.

Misclassification

Incorrectly billing an initial assessment instead of a re-assessment.

Frequency Limit Exceeded

Billing more than twice per year under non-admission conditions.

Misunderstanding Re-assessment Focus

Failure to focus on the specific problem instead of broader evaluations.

Document A114 correctly — every time

Empathia's templates automatically structure your notes to capture every required element for audit-proof billing.

Try Free Template Book a Demo

8Frequently Asked Questions

How many times can A114 be billed per year?

A114 can be billed up to twice per patient per physician in a consecutive 12-month period, except for hospital admissions.

What constitutes a valid A114 re-assessment in critical care?

A re-evaluation concerning specific ongoing critical care issues like tracheostomy weaning or persistent dyspnoea.

When should a complex re-assessment be billed instead of A114?

When the patient's condition requires a more thorough evaluation beyond the scope of the specific re-assessment.

Can A114 be conducted virtually?

Yes, A114 can be billed as A114A when the service is conducted via video or phone.

What type of follow-up would justify an A114 billing?

Follow-up for targeted post-critical care issues, such as management of tracheostomy or resolving severe dyspnoea.

Which conditions are typical for requiring re-assessment in a critical care setting?

Conditions include post-ICU recovery issues like respiratory system challenges or cardiovascular monitoring.

What should a doctor document for time recording in A114 billing?

Document the start and end times of the assessment in the patient's permanent medical records.

What patient scenario exemplifies a valid A114 case?

A patient returning from the ICU dealing with issues such as adjusting to breathing without assistance.

Disclaimer: This article is intended as a general educational resource for physicians and billing staff. It does not constitute billing advice or a definitive interpretation of the OHIP Schedule of Benefits. Always verify current billing codes, eligibility criteria, and documentation requirements directly against the official Schedule of Benefits or consult with a qualified medical billing specialist.

A114 OHIP Billing Code: Critical Care Re-assessment Insights

1What Is the A114 OHIP Code?

What is A114?

2Related Codes

3Eligibility Requirements

Eligibility Requirements

4What Your Clinical Note Must Show

5Weak vs. Strong Note Examples

6Common Reasons This Code Is Missed

8Frequently Asked Questions