C154 – 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 (Endocrinology & Metabolism) for a hospital in-patient, requiring a full, relevant history and physical examination of one or more systems.
When to Use
- Use C154 for a routine follow-up in-patient assessment when the patient's condition does not meet the complexity threshold required for C151.
- Apply C154 when performing an admission assessment for a patient you previously evaluated for the same illness in an outpatient setting prior to their hospital admission.
Common Pitfalls
- Billing C154 on the same day as a subsequent visit (C152) or any other assessment code by the same physician will result in a rejection.
- Attempting to claim the chronic disease premium (E078) with C154 is a common error, as E078 is strictly prohibited for hospital in-patient services.
- Exceeding the limit of two C154 claims per 12-month period without documenting the specific exception for prior outpatient assessment will trigger an automatic adjustment to a lower fee.
Billing Tips
- Prioritize C151 over C154 if the patient's condition is complex or serious, as C151 provides a higher fee and is appropriate when a formal written report to the referring physician is generated.
- Ensure your documentation clearly links the current in-patient assessment to the previous outpatient visit if you are billing C154 as an admission assessment to bypass the 12-month frequency limit.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Non-Emergency Hospital In-Patient Services
Assessment
Full, relevant history of the patient.
Physical examination of one or more systems.
Admission assessments are deemed to be a medical specific re-assessment if the patient was assessed by the physician prior to admission for the same illness.
For emergency calls and other special visits to in-patients, use General Listings and Premiums ( to ) when applicable.
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