C063 – Specific assessment - non-emergency hospital in-patient
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A specific assessment rendered by a specialist in Orthopaedic Surgery for a non-emergency hospital in-patient. This service requires 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.
When to Use
- Use C063 for the major preoperative assessment of an elective surgical patient who is already an inpatient, provided it is the visit where the decision to operate is finalized.
- Use C063 when performing a specific assessment on a non-emergency inpatient for a new, distinct orthopedic issue that arises during their hospital stay, separate from the reason for admission.
- Use C063 if you assessed a patient in the Emergency Department and subsequently admitted them, as this initial encounter serves as the admission assessment.
Common Pitfalls
- Billing C063 for a routine daily hospital visit; this code is strictly for a specific, detailed assessment and is limited to once per 12-month period per diagnosis.
- Attempting to bill C063 when a pre-operative assessment (e.g., A933 or C933) has already been rendered by you within the previous 30 days.
- Submitting C063 for a patient transfer within the same hospital, which is explicitly ineligible for an additional admission assessment fee.
Billing Tips
- If you are the Most Responsible Physician (MRP), ensure you append the E082 premium to your C063 claim to maximize the value of the admission assessment.
- If the patient presents a second time within 12 months for an unrelated diagnosis, document the distinct nature of the new condition clearly to justify the second C063 claim.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Assessment
Requires a direct physical encounter with the patient including taking a patient history and performing a physical examination.
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.
For surgeons (Orthopaedic Surgery), a hospital admission assessment is not eligible for payment unless it is the major preoperative visit (the assessment where the decision to operate is made).
Non-Emergency Hospital In-Patient Services include Acute Care Hospitals.
If the specialist assessed the patient in the Emergency Department (ED) or Out-Patient Department (OPD) and subsequently admits the patient, that initial assessment constitutes the admission assessment.
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