C113 – Complex neuromuscular assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
An assessment for the ongoing management of complex chronic neurological conditions where the complexity of the condition requires the continuing management by a neurologist and where the visit requires a minimum of 20 minutes in direct contact with the patient, exclusive of time spent rendering any other separately billable intervention to the patient.
When to Use
- Use C113 for the ongoing management of a patient with an established diagnosis of motor neurone disease or myasthenia gravis during an inpatient hospital stay.
- Use C113 for the inpatient follow-up of a patient with a primary CNS tumor or neurological complications of cancer therapy when the encounter requires at least 20 minutes of direct contact.
- Use C113 for the inpatient management of chronic, complex conditions like Huntington’s chorea when the complexity necessitates a comprehensive re-assessment.
Common Pitfalls
- Billing C113 for the initial inpatient consultation; this code is strictly for ongoing management and will be rejected or adjusted if used for the first evaluation.
- Failing to document specific start and stop times in the medical record, which triggers an automatic adjustment to a lower-valued assessment code.
- Applying C113 to uncomplicated conditions like carpal tunnel syndrome or Bell’s palsy, which are explicitly excluded from the eligibility criteria.
Billing Tips
- Ensure the medical record explicitly documents the 'medical specific re-assessment' elements to justify the complexity and prevent fee downgrades.
- Do not bill E078 on the same day as C113, as the two codes are mutually exclusive.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Assessment
Eligible conditions include: (1) Neuromuscular system diseases (generalized peripheral neuropathies, myopathies, diseases of the neuromuscular junction, or motor neurone diseases); (2) Chronic CNS disorders (malignant brain neoplasms, functional neurological disorder, chronic migraine/trigeminal autonomic cephalalgias, Huntington’s chorea, trigeminal neuralgia, intracranial hemorrhage, stroke); (3) Neuro-oncology conditions (primary CNS tumor, CNS metastasis, neurological complications of cancer therapy, paraneoplastic neurological syndromes).
Not intended for the evaluation and/or management of uncomplicated neurological disorders (e.g., carpal tunnel syndrome, Bell’s palsy, asymptomatic diabetic neuropathy).
A consultation or assessment service should be claimed for the initial evaluation; C113 is for ongoing management.
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