C133 – Subsequent visits - Nursing home or home for the aged
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A medical specific assessment is a service rendered by a specialist in Internal Medicine in a hospital in-patient setting (non-emergency). It requires 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 C133 as the initial admission assessment when you are the Most Responsible Physician (MRP) admitting a patient to the hospital for an internal medicine issue.
- Use C133 when a patient is transferred to your service from another physician and you are performing your first formal assessment of that patient during the current hospital stay.
Common Pitfalls
- Billing C133 when you have already performed a consultation (C130) for the same admission; you cannot bill both a consultation and an admission assessment for the same patient encounter.
- Attempting to bill C133 for a subsequent visit after the initial admission assessment; use the appropriate subsequent visit codes (e.g., C134) for follow-up days.
- Failing to recognize that if you assessed the patient in the Emergency Department prior to admission, that ED assessment is considered the admission assessment, rendering a subsequent C133 claim invalid.
Billing Tips
- Always append the E082 premium to your C133 claim if you are the MRP and meet the specific criteria regarding hospital remuneration to maximize your compensation for the admission.
- Ensure your documentation clearly distinguishes the C133 admission assessment from subsequent daily visits (C134), as auditors look for the 'initial' nature of the C133 service.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Hospital In-patient Services
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.
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