C181 – Complex medical specific re-assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A complex medical specific re-assessment is a re-assessment of a patient because of the complexity, obscurity, or seriousness of the patient's condition and includes all the requirements of a medical specific re-assessment. The physician must report his/her findings, opinions, or recommendations in writing to the patient's primary care physician or the amount payable for the service will be adjusted to a lesser assessment fee. As a 'C' prefix code, this service is rendered to a non-emergency hospital in-patient.
When to Use
- Use C181 when managing a complex, multi-system inpatient whose condition requires a detailed re-evaluation that exceeds the scope of a standard subsequent visit (C002).
- Use this code for patients with obscure diagnostic challenges where a formal written report to the referring primary care physician is mandatory to justify the higher fee.
- Select C181 over C183 when the clinical complexity necessitates a more comprehensive review of the patient's status and management plan.
Common Pitfalls
- Failure to send a formal written report to the primary care physician will trigger an automatic adjustment to a lower assessment fee.
- Exceeding the combined limit of 4 services per 12-month period (C181 and C183 combined) will result in the claim being downgraded to a standard visit fee.
- Billing C181 for patients in an emergency department setting is incorrect, as this code is strictly reserved for non-emergency hospital inpatients.
Billing Tips
- Ensure your written report to the primary care physician is dated and filed, as this is the primary audit trigger for the C181 fee.
- If the patient is in an ICU or CCU, remember to append the C101 premium to maximize the value of the C181 assessment.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
The physician must report his/her findings, opinions, or recommendations in writing to the patient's primary care physician.
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