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C131
C131 – Complex medical specific re-assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A re-assessment of a patient because of the complexity, obscurity, or seriousness of the patient’s condition. This service includes all the requirements of a medical specific re-assessment (full history of the presenting complaint, necessary physical examination, advice to the patient, and appropriate record).
When to Use
- Use C131 when managing a hospitalized patient with multi-system failure or diagnostic uncertainty that requires a more comprehensive review than a standard C134 re-assessment.
- Apply this code for patients requiring complex medication titration or management of severe, unstable chronic conditions that necessitate a detailed written report to the referring physician.
Common Pitfalls
- Billing C131 more than four times in a rolling 12-month period will trigger automatic rejections; track these dates carefully as they are cumulative with C134.
- Failing to document or send the required written report to the primary care physician will lead to a clawback of the fee to a lower-tier assessment code during an audit.
- Attempting to bill C131 in conjunction with E082 is prohibited, as the MRP premium is not applicable to this specific assessment code.
Billing Tips
- Ensure your clinical notes explicitly justify the 'complexity, obscurity, or seriousness' of the condition to satisfy audit requirements for the higher fee compared to C134.
- Always confirm that the patient is currently admitted as an in-patient at the time of service, as this code is strictly restricted to hospital settings.
Provider Fee$0.00
Specialist Fee$70.90
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Hospital In-Patient
Code Classes
Assessment
C131 is the hospital in-patient equivalent of the complex medical specific re-assessment.
Not eligible for age-based fee premiums (percentage increases).
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