C044 – Specific re-assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A specific re-assessment is an admission assessment rendered for the purpose of admitting a patient to a hospital or long-term care facility when the admitting physician has previously assessed the patient for the same presenting illness within 90 days of the admission.
When to Use
- Use C044 when you are the admitting physician and have already performed an assessment for the same presenting illness in your office or clinic within the 90 days prior to the hospital admission.
- Use C044 for an admission assessment to a long-term care facility or chronic care hospital when you have provided a prior assessment for the same condition within the 90-day window.
Common Pitfalls
- Billing C045 (Consultation) or C043 (Specific Assessment) instead of C044 when a prior assessment for the same illness occurred within 90 days, which will trigger a rejection or audit recovery.
- Attempting to bill C044 in addition to a subsequent hospital visit code (C042) on the same calendar day, as the admission assessment is intended to cover the full day's care.
- Billing C044 for patients in designated palliative care beds, as the code is explicitly restricted in those settings.
Billing Tips
- Always verify the date of your last office or clinic assessment for the presenting illness; if it is 90 days or less before the admission date, C044 is the mandatory code.
- Ensure you do not bill any special visit premiums (GP65-GP78) with C044, as these are ineligible for elective hospital admissions.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Hospital/Institutional Visit
Assessment
Direct physical encounter with the patient.
Taking a patient history and performing a physical examination.
Inquiry carried out to arrive as an opinion as to the nature of the patient’s condition.
Making arrangements for follow-up care.
Discussion with and providing advice/information to the patient or representative.
Non-Emergency Long-Term Care includes Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, and Homes for the Aged.
For emergency calls and other special visits to in-patients, use General Listings and Premiums ( to ) when applicable.
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