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C084
C084 – Specific re-assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A specific re-assessment is a service rendered by a specialist (Plastic Surgery, specialty 08) for a hospital in-patient. It requires a full, relevant history and physical examination of one or more systems.
When to Use
- Use C084 when performing an admission assessment for a patient you have already assessed for the same presenting illness within the previous 90 days.
- Use C084 for a formal, comprehensive re-assessment of a hospital in-patient that exceeds the scope of a standard subsequent visit (C082).
Common Pitfalls
- Billing C084 for routine daily rounds; it is intended for a specific, documented re-assessment of one or more systems, not for general follow-up.
- Attempting to bill C084 in addition to a consultation (C085) or another assessment on the same day, which will trigger a rejection due to the 'one assessment per admission' rule.
- Exceeding the 2-per-12-month limit for non-admission related re-assessments, as the system will automatically flag and reject the third claim.
Billing Tips
- If you are the Most Responsible Physician (MRP) performing the admission assessment, remember to append the E082 premium to C084 to increase the fee by 30%.
- Ensure your clinical notes explicitly detail the 'full, relevant history and physical examination' to satisfy audit requirements for this specific code.
Provider Fee$0.00
Specialist Fee$30.00
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Consultations and Visits
Code Classes
Assessment
Requires a full, relevant history and physical examination of one or more systems.
If rendered as an admission assessment, it applies when the admitting physician has previously assessed the patient for the same presenting illness within 90 days.
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