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C114
C114 – Medical specific re-assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A medical specific re-assessment is a service rendered by a specialist in Critical Care Medicine for a hospital in-patient. It requires a full, relevant history and physical examination of one or more systems.
When to Use
- Use C114 as the initial admission assessment for a patient when you have already assessed them for the same condition within the previous 90 days, as this precludes the use of a consultation code.
- Use C114 for the initial hospital admission assessment when you are the Most Responsible Physician (MRP) and the patient is admitted for a condition requiring Critical Care Medicine expertise.
Common Pitfalls
- Billing C114 for subsequent daily hospital visits; these must be billed as subsequent visit codes (e.g., C112) once the initial admission assessment is completed.
- Attempting to bill C114 when you are already in the hospital for other patients; C114 is for the initial admission assessment, not for routine rounding on existing patients.
- Failing to recognize that C111 is the correct code if the patient's condition is of such complexity, obscurity, or seriousness that it warrants a higher-level assessment and a formal written report to the referring physician.
Billing Tips
- If you are called into the hospital specifically to perform an admission assessment, ensure you append the appropriate Special Visit Premium to C114 to maximize your claim.
- If you are the MRP, remember to add the E082 premium to your C114 claim to receive the 30% increase, provided you meet the specific remuneration criteria for the MRP.
Provider Fee$0.00
Specialist Fee$65.90
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Hospital In-patient
Code Classes
Assessment
Full, relevant history of the patient.
Physical examination of one or more systems.
Appropriate medical record documentation.
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