All codes
C013
C013 – Specific assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A service rendered by a specialist in anaesthesia for a hospital in-patient, requiring a full history of the presenting complaint and detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis, and/or exclude disease, and/or assess function.
When to Use
- Use C013 for a comprehensive pre-operative assessment of an inpatient performed on a day prior to the scheduled surgery date.
- Use C013 as the initial admission assessment for an inpatient if no prior assessment for the same illness has been billed by you in the last 90 days.
Common Pitfalls
- Billing C013 on the same day as an anaesthesia procedure (suffix C) will result in automatic rejection, as the pre-anaesthetic evaluation is considered part of the procedure fee.
- Attempting to bill C013 if a previous assessment for the same illness occurred within the last 90 days is an audit risk; use C014 instead.
- Billing C013 when a surgery is cancelled prior to induction is incorrect; you must bill C012 (subsequent visit) for that encounter.
Billing Tips
- Ensure the 12-month frequency limit is tracked, as C013 is restricted to once per patient per physician per year.
Provider Fee$0.00
Specialist Fee$64.65
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Hospital In-Patient
Code Classes
Assessment
Constitutes the admission assessment if no previous assessment for the same illness within 90 days.
If previously assessed within 90 days, use C014 (Specific re-assessment).
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