C093 – Specific assessment
OHIP Surgical Procedures Code — CARDIAC SURGERY (09) · Schedule of Benefits
A specific assessment is a service rendered by a specialist in Cardiac Surgery for a hospital in-patient, requiring 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 C093 for the initial hospital admission assessment when you are the Most Responsible Physician (MRP) for a patient admitted for elective cardiac surgery.
- Use C093 when performing a detailed assessment of a new, unrelated clinical issue in an existing cardiac surgery inpatient that requires a comprehensive history and physical exam.
Common Pitfalls
- Billing C093 when the patient was previously assessed by you for the same presenting illness within the last 90 days, which must be billed as C094 instead.
- Attempting to bill C093 for emergency admissions or urgent consults in the ED, where you should instead use the 'A' prefix codes (e.g., A093) combined with applicable emergency premiums.
- Billing C093 for a transfer within the same hospital, which is explicitly prohibited by the billing rules for this code.
Billing Tips
- Always append the E082 premium to C093 if you are the MRP performing the admission assessment, provided you meet the hospital remuneration eligibility criteria.
- Ensure your documentation clearly distinguishes the C093 assessment from subsequent daily visits (C092) by focusing on the diagnostic or functional assessment requirements rather than routine follow-up.
Effective: June 1, 2025
A. Consultations and Visits
CARDIAC SURGERY (09)
Hospital In-Patient
Assessment
Full history of the presenting complaint.
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 a patient is assessed by a specialist in the ED or OPD and subsequently admitted, the initial assessment constitutes the admission assessment.
C093 is listed under 'NON-EMERGENCY HOSPITAL IN-PATIENT SERVICES' for Cardiac Surgery (09).
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