All codes
C204
C204 – Specific re-assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A 'C' prefix code for non-emergency acute care hospital in-patient services, as outlined in . A specific re-assessment is a service rendered by a specialist that requires a full, relevant history and physical examination of one or more systems, as defined in . This code is to be used by specialists in Obstetrics and Gynaecology (20). Note: The collection of cervical cancer screening specimen(s) is included in the specific re-assessment when a pelvic examination is a normal part of the service, as per page .
When to Use
- Use C204 for a formal, comprehensive re-assessment of an inpatient requiring a full history and physical examination of one or more systems, distinct from a routine daily C205 subsequent visit.
- Select C204 when managing a new, acute clinical development in an admitted patient that necessitates a complete re-evaluation of the patient's status rather than a standard progress check.
Common Pitfalls
- Billing C204 more than twice in a 12-month period for non-hospitalized patients will trigger a payment adjustment to a lower fee, as the exemption only applies to hospital admissions.
- Attempting to bill E430 or E431 for cervical cancer screening alongside C204 will result in a rejection, as the specimen collection is considered bundled into the re-assessment fee.
Billing Tips
- Ensure your documentation explicitly reflects a full history and physical examination of the relevant systems to satisfy the GP23 definition, as C204 requires more clinical depth than a standard C205 subsequent visit.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.