C003 – General assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A general assessment is a service rendered for a hospital in-patient that requires a full history (including history of the presenting complaint, family medical history, past medical history, social history, and a functional inquiry into all body parts and systems) and, except for breast, genital or rectal examination where not medically indicated or refused, an examination of all body parts and systems. It may include a detailed examination of one or more parts or systems.
When to Use
- Use C003 for a comprehensive hospital admission assessment when you are the primary physician and have not assessed the patient for the same illness within the preceding 90 days.
- Use C003 for an annual or periodic general assessment of a long-term hospital in-patient, provided the 12-month frequency limit is respected.
- Use C003 as the major preoperative visit by a surgeon, as it encompasses the required full history and systemic physical examination.
Common Pitfalls
- Billing C003 when a patient was seen by you for the same condition within 90 days; this must be billed as C004 (General re-assessment) instead.
- Attempting to bill C003 in addition to a consultation (C005) or re-assessment (C004) for the same hospital admission, which is strictly prohibited by the 'one per admission' rule.
- Failing to document a functional inquiry into all body systems, which is a mandatory requirement for C003 that is often audited.
Billing Tips
- If you anticipate spending significant time stabilizing a complex patient during the admission, remember that K001 (Detention) can be added to C003 only after the first 60 minutes of service.
- Ensure your admission note explicitly lists the systems reviewed and examined to meet the 'full history and physical' threshold, as generic 'systemic review normal' notes are frequently rejected in audits.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Non-emergency hospital in-patient services
Assessment
Requires a full history: presenting complaint, family medical, past medical, social, and functional inquiry into all body parts and systems.
Requires a physical examination of all body parts and systems (except breast, genital, or rectal if not indicated or refused).
C003 is specifically for non-emergency hospital in-patient services.
Not eligible for virtual care billing (not listed in Appendix J).
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