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C071

C071Complex medical specific re-assessment

OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits

A complex medical specific re-assessment is a re-assessment of a patient because of the complexity, obscurity, or seriousness of the patient’s condition and includes all the requirements of a medical specific re-assessment. It is rendered by a specialist in Geriatrics for an in-patient in a non-emergency hospital setting.

When to Use

  • Use C071 for an inpatient geriatric patient (65+) requiring a comprehensive re-evaluation of a complex, multi-system condition that exceeds the scope of a standard C074 re-assessment.
  • Use C071 for patients under 65 specifically when the clinical focus is the assessment of dementia, provided the complexity warrants the higher fee over a standard assessment.

Common Pitfalls

  • Billing C071 more than 4 times in a 12-month period per patient, which triggers an automatic adjustment to a lower assessment fee as it shares the limit with C073.
  • Failing to document and send a formal written report to the primary care physician, which results in the claim being downgraded to a lesser assessment fee upon audit.

Billing Tips

  • Ensure the clinical note clearly justifies the 'complexity or obscurity' of the condition to support the use of C071 over the lower-valued C074 re-assessment code.
Provider Fee$0.00
Specialist Fee$91.90

Effective: June 1, 2025

Category

A. Consultations and Visits

Subcategory

CONSULTATIONS AND VISITS

Service Type

In-patient

Code Classes

Assessment

C071 is the in-patient equivalent of A071 and is subject to the same clinical conditions.

If the physician has previously assessed the patient for the same presenting illness within 90 days, the service is billed as a re-assessment (C071 or C074) rather than an initial assessment (C073).

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