1What Is the A313 OHIP Code?
A313 represents the Medical Specific Assessment billing code used by physiatrists in Ontario under the OHIP schedule. This code is utilized for a comprehensive assessment involving the history and detailed examination necessary to diagnose, exclude disease, or assess function of a regionally affected area or system. Common clinical contexts include cases where a patient presents with a single regional issue, such as a painful shoulder or focal neuropathy.
This assessment focuses on impairment and treatment considerations rather than developing a full rehabilitation plan. Despite its apparent straightforwardness, A313 can be overlooked when the specific rules for eligible assessments, including temporal, diagnostic, and location constraints, are not fully understood.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| C313 | Medical specific assessment | Up to two per 12 months under specified circumstances | Equivalent service for hospital in-patients. |
| W314 | General re-assessment of patient in nursing home | Varies, typically more frequent | Re-assessment with lower fee, for nursing home settings. |
| A310 | Medical specific re-assessment | Varies; typically for follow-up within 12 months | Use when a re-assessment of a previous specific issue is needed. |
| A311 | Complex medical specific re-assessment | Varies; more complex or detailed follow-up | For complex evaluations possibly involving new or unresolved issues. |
3Eligibility Requirements
For eligibility under the A313 OHIP code:
- Service Location: Must be performed by a specialist in a location other than the patient's home.
- Service Details: Requires a complete history of the presenting complaint and a detailed examination of the affected body part(s) or system(s).
- Frequency Limit: Limited to one per patient per physician every 12 months unless:
- A different, unrelated diagnosis warrants a second visit, or
- At least 90 days have passed and the second assessment is associated with a hospital admission.
Time Recording: The specific assessment is not payable without time records on the patient's profile, specifying start and end times.
4What Your Clinical Note Must Show
Ensure recording of service times on the patient’s medical chart.
- Start and end times must be clearly noted.
Complete history and examination should be documented.
- Detailed examination of the affected area.
- History of the presenting complaint.
5Weak vs. Strong Note Examples
The strong note is effective because it provides detailed specifics about the history and examination, whereas the weak note lacks detail and does not demonstrate the service's complexity or duration.
Evaluation of shoulder pain. Completed the assessment.
Comprehensive assessment of the patient's painful right shoulder.
History and examination included:
- Detail of pain onset, duration, and impact on daily activities.
- Full range of motion assessment and specific tests.
