C014 – Specific re-assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A specific re-assessment is a service rendered by a specialist (specifically Anaesthesia for code C014) to a hospital in-patient. It requires a full, relevant history and physical examination of one or more systems.
When to Use
- Use C014 when performing a comprehensive pre-operative assessment for an inpatient who was previously evaluated by you for the same condition in an outpatient setting.
- Use C014 for a detailed, system-specific re-evaluation of a hospitalized patient's anaesthetic status when a routine subsequent visit (C013) is insufficient to capture the complexity of the required history and physical.
Common Pitfalls
- Billing C014 during routine daily hospital rounds is a common audit trigger; it is strictly intended for specific, non-routine re-assessments.
- Attempting to bill C014 for a pre-operative assessment when the surgery is cancelled prior to induction will result in rejection, as these must be billed as a hospital subsequent visit.
- Exceeding the limit of two per patient per 12-month period without documenting that the service was specifically for a hospital admission, which is the only exception to the frequency cap.
Billing Tips
- If the assessment requires significant time, ensure you document the duration to support the addition of K001, which is only payable if the C014 service exceeds 40 minutes.
- Always verify if the patient qualifies for C960-C964 or C990-C997 premiums, as these can be claimed alongside C014 for non-elective, urgent hospital visits.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Hospital In-Patient Service
Assessment
Requires a full, relevant history and physical examination of one or more systems.
If the assessment is for a hospital admission, it is deemed a specific re-assessment if the physician has assessed the patient prior to admission for the same illness.
If an anaesthesiologist examines a patient prior to surgery and the surgery is cancelled prior to the induction of anaesthesia, the service rendered constitutes a hospital subsequent visit (not C014).
C014 is specifically listed under the Anaesthesia (01) section for non-emergency hospital in-patient services.
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