C043 – Specific assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Specific assessment is a service rendered by specialists, in a place other than a patient’s home, and 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.
When to Use
- Use C043 as the initial admission assessment when you are the Most Responsible Physician (MRP) for a neurosurgical patient admitted for a new, unrelated condition.
- Use this code when performing a detailed, system-specific examination in a hospital setting that does not meet the complexity requirements of a full consultation (C045).
Common Pitfalls
- Billing C043 when the patient was previously assessed by you for the same illness within 90 days; this must be billed as a specific re-assessment (C044).
- Submitting C043 for a patient transfer within the same hospital, which is ineligible for an additional admission assessment fee.
- Exceeding the 12-month limit of one C043 per patient without ensuring the second assessment is for a clearly different and unrelated diagnosis.
Billing Tips
- Always append the E082 premium when billing C043 as an admission assessment to increase the fee by 30%, provided you are the MRP.
- Ensure your documentation explicitly distinguishes the new diagnosis from previous ones to justify a second C043 within a 12-month period.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Hospital In-patient
Assessment
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.
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