C203 – Specific assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A specific assessment rendered for a non-emergency hospital in-patient by a specialist in Obstetrics and Gynaecology (20). As per , the 'C' prefix designates this service for acute care hospital non-emergency in-patient settings. A specific assessment requires a full history of the presenting complaint and 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, as defined in .
When to Use
- Use C203 for a focused, non-emergency assessment of an inpatient when the clinical scenario does not meet the complexity requirements of a consultation (C205).
- Use C203 for daily or periodic inpatient follow-up assessments where the patient's condition has changed or requires a specific diagnostic review that exceeds the scope of a routine subsequent visit (C202).
- Use C203 when performing a specific diagnostic evaluation for a new, unrelated gynecological issue in an existing inpatient who is already being managed for a different primary diagnosis.
Common Pitfalls
- Billing C203 with a special visit premium (e.g., K962) will result in a rejection; you must use the 'A' prefix equivalent (A203) if a premium is applicable.
- Attempting to bill E430 or E431 for a Pap smear collection during a C203 inpatient visit is prohibited, as the collection is considered bundled into the assessment fee.
- Exceeding the frequency limit of one C203 per 12-month period (or two for unrelated diagnoses) will trigger an automatic adjustment to a lower-valued assessment code.
Billing Tips
- Always ensure your documentation explicitly supports the 'specific' nature of the assessment by detailing the history of the presenting complaint and the specific systems examined to justify the higher fee over a standard subsequent visit (C202).
- If the patient is located in an ICU or CCU, remember to append the C101 premium to the C203 claim to capture the additional institutional intensity fee.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
The collection of cervical cancer screening specimen(s) is included in the consultation, repeat consultation, general or specific assessment (or re-assessment), or routine post-natal visit when pelvic examination is normal part of the foregoing services. However, the add-on codes E430 or E431 can be billed in addition to these services when collection of cervical cancer screening specimen(s) is performed outside of a hospital or IHCSC.
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