C033 – Specific assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A specific assessment for a non-emergency hospital in-patient provided by a physician with the specialty designation of General Surgery (03). As defined in , a specific assessment requires 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. The 'C' prefix designates this service for acute care hospital non-emergency in-patient settings, as outlined in and .
When to Use
- Use C033 for the initial hospital admission assessment of a patient by a General Surgeon when the patient has not been assessed for the same illness by the same physician within the previous 90 days.
- Use C033 for a subsequent hospital visit where the patient presents with a new, distinct surgical issue requiring a full history and detailed examination of the affected system, rather than a routine follow-up.
- Use C033 when performing a specific assessment on a non-emergency inpatient that exceeds the scope of a C034 (Specific Re-assessment) but does not meet the criteria for a full consultation (C032).
Common Pitfalls
- Billing C033 when a patient has been transferred from another physician within the same hospital; per GP40, only one admission assessment is payable per patient admission.
- Attempting to bill C033 for a follow-up visit on the same day as a surgical procedure, which is generally considered included in the surgical fee unless the assessment is for an unrelated condition.
- Failing to document the specific 'full history' and 'detailed examination' required by GP23, which leads to automatic rejection or clawbacks during post-payment audits.
Billing Tips
- If the patient is in the ICU or CCU, ensure you append the C101 premium to the C033 claim to maximize the value of the visit.
- Always verify if the patient was seen by you for the same presenting illness in the last 90 days; if so, you must use C034 instead of C033 to avoid rejection.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments, Hospital and Institutional Consultations and Assessments
In addition to standard medical record-keeping, the record must document a full history of the presenting complaint and a 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.
A specific assessment may constitute a hospital admission assessment if rendered for that purpose and the physician has not previously assessed the patient for the same presenting illness within 90 days of the admission assessment. Refer to for detailed admission assessment rules.
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