C074 – Medical specific re-assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Medical specific re-assessment- subject to the same conditions as A074. A medical specific re-assessment is a service rendered by a specialist for a non-emergency in-patient in an acute care hospital. This service requires a full, relevant history and physical examination of one or more systems, including the specific elements of assessments outlined in . As per , an admission assessment may be deemed a medical specific re-assessment if the patient was assessed by the same physician for the same illness prior to admission.
When to Use
- Use C074 when admitting a patient to an acute care hospital for the same illness for which you previously assessed them in your office or clinic.
- Use C074 for a non-emergency in-patient re-assessment when you have already reached the limit for C073 (Medical Specific Assessment) or when the clinical encounter meets the definition of a re-assessment rather than a new consultation.
- Use C074 for subsequent hospital visits when the patient's condition requires a full, relevant history and physical examination of one or more systems, provided you have not exceeded the annual frequency limits.
Common Pitfalls
- Billing C074 as an admission assessment when you have not previously assessed the patient for the same illness, which should instead be billed as a consultation (C003) if eligible.
- Exceeding the limit of two C074 codes per patient per 12-month period, which triggers an automatic adjustment to a lower assessment fee.
- Failing to recognize that C074 counts toward the global limit of four 'Medical Specific Assessments' and 'Complex Medical Specific Re-assessments' per patient per 12-month period.
Billing Tips
- If you are seeing a patient in the ICU or CCU, remember to append the C101 premium to your C074 claim to capture the additional value for the intensive care setting.
- Ensure your documentation explicitly links the current hospital admission to the prior office assessment to justify the use of C074 as an admission assessment under GP40.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
See General Preamble to for rules on Non-Emergency Hospital In-Patient Services.
For emergency calls and other special visits to in-patients, use General Listings (“A” prefix) and Premiums when applicable - see General Preamble to .
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