1What Is the A628 OHIP Code?
What is A628?
The A628 billing code under OHIP is designated for partial assessments in the field of Allergy and Immunology. It covers brief evaluations where the physician addresses limited aspects of the patient's condition. Common scenarios include follow-ups on the patient’s response to immunotherapy or reviewing the results of skin tests.
Because this assessment is not comprehensive, it is typically completed when a full examination is unnecessary. Despite its focused nature, physicians must ensure thorough documentation to meet billing criteria, which can sometimes lead to underutilization due to the strict record-keeping requirements.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A623 | Medical specific assessment | Governed by specialty | More comprehensive assessment in Clinical Immunology. |
| C623 | Medical specific assessment | Governed by specialty | Hospital in-patient equivalent for A623. |
| A621 | Complex medical specific re-assessment | Governed by specialty | In-depth reassessment in Clinical Immunology. |
| A624 | Medical specific re-assessment | Governed by specialty | Standard reassessment following initial assessments. |
3Eligibility Requirements
Eligibility Requirements for A628
To bill code A628, a physician must conduct a partial assessment involving:
- The history of the presenting complaint
- A necessary physical examination
- Advice provided to the patient
- Appropriate documentation and recording of the service
Time Recording Obligations
Under General Preamble GP7, physicians must note the start and end time of the service in the patient's permanent medical record. Services not meeting these criteria may not be eligible for reimbursement.
Virtual Delivery
According to Appendix J, Section 1, A628 may be billed for services rendered virtually, using A628A for virtual assessments via video or telephone.
Hospital In-Patient Services
When the same service is provided to a hospital in-patient, use code C628.
4What Your Clinical Note Must Show
To ensure eligibility for billing A628, physicians must maintain detailed records as follows:
- Record the start and end times of the assessment.
- Document patient history related to the presenting complaint.
- Perform and note the necessary physical examination results.
- Include advice or instructions given to the patient.
- Ensure all information is entered into the patient's permanent medical record.
5Weak vs. Strong Note Examples
The strong note succeeds because it provides specific details about the service and follow-up plan, ensuring comprehensive documentation. The weak note lacks depth and misses the required start and end times.
Checked skin test results. Advised to continue current treatment.
Visited due to reaction to immunotherapy.
Reviewed skin test results indicating mild reaction.
Conducted physical examination of skin reaction area.
Advised patient to adjust dosage, return in two weeks.
Service from 10:00 AM to 10:20 AM.
- Context and reason for visit given.
- Detailed advice and follow-up plan documented.
- Precise service timing recorded.
