C174 – Specific re-assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A specific re-assessment rendered by a vascular surgery specialist for a non-emergency hospital in-patient. This service requires a full, relevant history and physical examination of one or more systems. As per , the 'C' prefix indicates the service is for an acute care hospital non-emergency in-patient. In addition to the common elements, this assessment includes the following specific elements as defined on : - A. A direct physical encounter with the patient including taking a patient history and performing a physical examination. - B. Other inquiry (including taking a patient history), carried out to arrive at an opinion as to the nature of the patient's condition, (whether such inquiry takes place before, during or after the encounter during which the physical examination takes place) and/or follow-up care. - C. Performing any procedure(s) during the same encounter as the physical examination, unless the procedure(s) is(are) separately listed in the Schedule and an amount is payable for the procedure in conjunction with an assessment. - D. Making arrangements for any related assessments, procedures or therapy, and/or interpreting results. - E. Making arrangements for follow-up care. - F. Discussion with, and providing advice and information, including prescribing therapy to the patient or the patient's representative, whether by telephone or otherwise, on matters related to the service and results. - G. When medically indicated, monitoring the condition of the patient and intervening, until the next insured service is provided. - H. Providing premises, equipment, supplies, and personnel for the specific elements of the service except for any aspect(s) that is (are) performed in a hospital or nursing home.
When to Use
- Use C174 for daily follow-up assessments of a vascular surgery inpatient who is already under your care for the same condition.
- Use C174 when performing a pre-operative assessment for a patient you previously consulted on and admitted for a scheduled vascular procedure.
- Use C174 for a specific re-assessment of a vascular patient when the clinical status changes, requiring a new history and physical examination of one or more systems.
Common Pitfalls
- Do not bill C174 if you are also billing a consultation (C074) for the same patient on the same day, as only one assessment is payable.
- Avoid billing C174 in conjunction with special visit premiums; these are restricted to 'A' prefix codes and will be rejected if submitted with 'C' codes.
- Do not bill C174 for the initial hospital admission assessment unless it qualifies as the 'major pre-operative visit' where the decision to operate is finalized.
Billing Tips
- Ensure your documentation clearly reflects a full, relevant history and physical examination to justify the 'specific re-assessment' status over a standard subsequent visit.
- If the patient meets the criteria for a trauma premium, ensure the ISS score is explicitly documented in the chart to support the addition of E420.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments, Hospital and Institutional Consultations and Assessments
All insured services must be documented in appropriate records. The Act requires that the record establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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