C184 – Medical specific re-assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A medical specific re-assessment rendered by a neurologist for a non-emergency hospital in-patient. As defined in the Schedule of Benefits on page , a medical specific re-assessment is a service rendered by a specialist that requires a full, relevant history and physical examination of one or more systems. It is often used for hospital admission assessments if the admitting physician has previously assessed the patient for the same presenting illness within 90 days of the admission assessment (see page ).
When to Use
- Use C184 when performing a hospital admission assessment for a patient you have already assessed for the same condition within the previous 90 days.
- Use C184 for a subsequent inpatient re-assessment by a neurologist that requires a full, relevant history and physical examination of one or more systems.
- Use C184 when the clinical complexity of the inpatient follow-up exceeds the scope of a standard subsequent visit (C183) and necessitates a comprehensive re-evaluation.
Common Pitfalls
- Billing C184 for routine daily inpatient follow-ups that do not meet the strict requirement of a full, relevant history and physical examination.
- Exceeding the limit of two C184 claims per 12-month period for non-admission scenarios, which triggers an automatic adjustment to a lower assessment fee.
- Failing to recognize that C184 is specific to neurologists; billing this code as a non-neurologist will result in immediate rejection.
Billing Tips
- If the patient is located in an ICU or CCU, ensure you append the C101 premium to the C184 claim to capture the additional fee for the specialized setting.
- Document the specific systems examined and the clinical necessity for the full re-assessment to defend against potential post-payment audits regarding the 're-assessment' definition.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
See General Preamble to . For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable - see General Preamble to .
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