C153 – Medical specific assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A medical specific assessment rendered by a specialist in Endocrinology & Metabolism to a hospital in-patient. 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, exclude disease, and/or assess function.
When to Use
- Use C153 as the initial inpatient assessment for a new endocrine consultation when the patient has not been seen by you for the same illness within the previous 90 days.
- Use C153 when performing a focused, system-specific inpatient evaluation that does not meet the complexity requirements of a full consultation (A153) but exceeds the scope of a subsequent visit (C152).
Common Pitfalls
- Billing C153 when a consultation (A153) is more appropriate; if you are providing a formal opinion requested by another physician, A153 is the correct code.
- Exceeding the 4-service limit per 12-month period by failing to distinguish between C153, C154, and C151, which all count toward the same annual cap.
- Attempting to bill C153 for a patient transfer within the same hospital; only one admission assessment is payable per patient per admission.
Billing Tips
- If you have seen the patient for the same endocrine condition within the last 90 days, bill C154 (Medical specific re-assessment) instead of C153 to avoid automatic rejection.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
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.
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