C233 – Specific assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A specific assessment performed by a specialist in Ophthalmology (23) for a non-emergency hospital in-patient. According to the General Preamble (), a specific assessment requires a full history of the presenting complaint and a detailed examination of the affected part(s), region(s), or system(s) to make a diagnosis, exclude disease, and/or assess function. The 'C' prefix indicates the service is for an acute care hospital in-patient, as defined in and . For emergency calls or special visits to in-patients, the 'A' prefix General Listings codes should be used instead, along with applicable special visit premiums.
When to Use
- Use C233 for a planned, non-emergency follow-up assessment of an ophthalmology inpatient where a detailed examination of a specific system is required.
- Use C233 when the patient has been previously assessed by you for a different condition within the same 12-month period, provided the current diagnosis is clearly unrelated.
Common Pitfalls
- Billing C233 when a special visit premium is applicable; you must use A233 instead to ensure the premium is processed correctly.
- Attempting to bill a procedure code separately when it is considered included in the C233 assessment fee under GP15.
- Exceeding the 12-month frequency limit without documenting a distinct, unrelated diagnosis, which leads to automatic payment adjustments to a lower assessment fee.
Billing Tips
- If you perform a procedure during the same encounter, verify if the procedure code is explicitly listed as 'payable in addition to an assessment' in the Schedule to avoid a rejection of the procedure claim.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
As per , all assessments must include a direct physical encounter with the patient, history taking, and physical examination.
All insured services must be documented in the medical record to establish that the service was provided, was medically necessary, and is the service for which the account is submitted ().
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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