C051 – Complex medical specific re-assessment
OHIP Surgical Procedures Code — COMMUNITY MEDICINE (05) · Schedule of Benefits
A re-assessment of a patient because of the complexity, obscurity, or seriousness of the patient’s condition. It includes all the requirements of a medical specific re-assessment.
When to Use
- Use C051 when managing a complex, multi-system inpatient whose condition has deteriorated or become obscure, requiring a comprehensive re-evaluation that exceeds the scope of a standard C054.
- Use C051 for the initial admission assessment when you have already assessed the patient for the same presenting illness in your office within the 90 days preceding the hospital admission.
Common Pitfalls
- Failure to send a formal written report to the primary care physician will result in an automatic downward adjustment of the fee to a lesser assessment code.
- Exceeding the 4-service limit per 12-month period per patient will trigger an automatic payment adjustment to a lower-valued assessment code.
- Billing C051 in addition to an E082 premium for the same encounter is often misunderstood; ensure the documentation clearly supports the complexity required for C051 beyond the standard admission assessment.
Billing Tips
- Always ensure your clinical notes explicitly document the 'complexity, obscurity, or seriousness' of the patient's condition to justify the use of C051 over the standard C054.
- When transferring care, remember that only one assessment/re-assessment is payable per admission; avoid billing C051 if a colleague has already billed a consultation or assessment for the same admission.
Effective: June 1, 2025
A. Consultations and Visits
COMMUNITY MEDICINE (05)
Hospital In-patient (Non-emergency)
Assessment
If the admitting physician has previously assessed the patient for the same presenting illness within 90 days of the admission assessment, the admission assessment constitutes a specific re-assessment or medical specific re-assessment (e.g., C051).
For emergency calls and other special visits to in-patients, use General Listings (A051) and Premiums when applicable ( to ).
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