C034 – Specific re-assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
C034 is a specific re-assessment rendered by a specialist for a non-emergency hospital in-patient. As per , a specific re-assessment requires a full, relevant history and physical examination of one or more systems. According to , the 'C' prefix designates this service for acute care hospital – non-emergency in-patient services.
When to Use
- Use C034 for a subsequent hospital visit where a full, relevant history and physical examination of one or more systems is performed, distinguishing it from a routine C032 subsequent visit.
- Use C034 when a surgical specialist performs an admission assessment for a patient they previously assessed for the same illness within 90 days, as this is deemed a specific re-assessment rather than a new consultation.
- Use C034 for a hospital admission assessment when the admitting physician has already assessed the patient for the same presenting illness within the preceding 90-day window.
Common Pitfalls
- Billing C034 when only a brief interval note is documented; failing to record a full, relevant history and physical examination of at least one system will result in a clawback upon audit.
- Attempting to bill C034 alongside another assessment code during the same patient encounter; only one assessment fee is payable per visit by the same physician.
- Exceeding the one-per-admission limit for specific assessments; claims exceeding this threshold are automatically adjusted to a lesser assessment fee by the Ministry.
Billing Tips
- Ensure the medical record explicitly documents the 'relevant history' and 'physical examination' components to satisfy the GP23 and GP15 requirements for a specific re-assessment.
- If providing care in an ICU or CCU setting, append the C101 premium to C034, provided no other fee-for-service assessment or team fee is claimed for that visit.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments, Hospital and Institutional Consultations and Assessments
Requires documentation of a full, relevant history and physical examination of one or more systems in the patient's medical record.
All insured services must be documented in the medical record to establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.
All services described as assessments must include the specific elements outlined in : a direct physical encounter, history, physical examination, and other components as required.
A hospital admission assessment constitutes a specific re-assessment if the admitting physician has previously assessed the patient for the same presenting illness within 90 days of the admission assessment ().
Admission assessments are deemed to be a specific re-assessment for those procedures prefixed with a 'Z' or noted as an IOP, by a surgical specialist who has assessed the patient prior to admission in respect of the same illness, or for those patients who have been assessed by a physician and subsequently admitted to the hospital for the same illness by the same physician (, ).
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