C064 – Specific re-assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A specific re-assessment is a service rendered by a specialist in a non-emergency hospital in-patient setting. It requires a full, relevant history and physical examination of one or more systems.
When to Use
- Use C064 for the admission assessment of an inpatient if you have previously assessed the patient for the same presenting illness within the preceding 90 days.
- Use C064 for a formal, comprehensive re-assessment of an existing inpatient when a significant change in clinical status requires a full history and physical examination, provided the annual limit has not been exceeded.
- Use C064 as the major preoperative visit for a surgical patient when the admission assessment is not otherwise billable.
Common Pitfalls
- Billing C064 when a standard subsequent visit (C062 or C122) is more appropriate, as C064 is intended for a comprehensive re-assessment rather than routine daily rounding.
- Attempting to bill C064 for a patient transfer between physicians in the same hospital, which is explicitly prohibited by the Schedule of Benefits.
- Exceeding the limit of two services per 12-month period for non-admission related re-assessments, leading to automatic claim rejections.
Billing Tips
- Ensure your documentation explicitly reflects the 'full, relevant history and physical examination' requirement, as this distinguishes C064 from a standard subsequent visit (C062).
- If you are the admitting surgeon, verify if you have seen the patient in your office within 90 days for the same condition; if so, bill C064 for the admission assessment instead of a standard consult or assessment code.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Assessment
Requires a full, relevant history.
Requires a physical examination of one or more systems.
Must include the specific elements of assessments as defined in (direct physical encounter, history, physical exam, inquiry, procedures, arrangements, follow-up, discussion, monitoring, etc.).
C064 is specifically for Orthopaedic Surgery (06) in the hospital in-patient setting.
For surgical specialists, the admission assessment is deemed a specific re-assessment if the physician has assessed the patient prior to admission in respect of the same illness.
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