C234 – Specific re-assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A specific re-assessment is a service rendered by specialists and requires a full, relevant history and physical examination of one or more systems. As outlined on page of the Schedule, an admission assessment may be deemed a specific re-assessment under specific circumstances, such as when a patient who has been previously assessed by a physician is subsequently admitted to the hospital for the same illness by the same physician.
When to Use
- Use C234 when you admit a patient to the hospital for the same illness for which you previously provided an office consultation or assessment.
- Use C234 for a hospital-based re-assessment when a patient is re-admitted for the same condition within a timeframe that does not qualify for a new consultation (A234).
- Use C234 for surgical specialists performing an admission assessment for a patient they have already evaluated in the office for the same surgical procedure.
Common Pitfalls
- Billing C234 more than twice in a 12-month period for the same patient will trigger an automatic reduction to a lesser assessment fee unless the service is specifically for a hospital admission.
- Confusing C234 with a subsequent visit (C232) is a common audit risk; C234 requires a full, relevant history and physical exam, whereas C232 is for routine daily follow-up.
- Failing to document the 'same illness' connection in the chart can lead to recovery of funds during a Ministry audit if the service is flagged as a duplicate or routine visit.
Billing Tips
- Ensure your documentation explicitly states the 'relevant history and physical examination' of the systems involved to satisfy the specific requirements of a C234 versus a standard subsequent visit.
- If you are the admitting physician, always bill C234 for the admission assessment rather than a subsequent visit code (C232) to ensure you are compensated for the comprehensive nature of the admission work.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
A specific re-assessment requires documentation of a full, relevant history and physical examination of one or more systems.
See General Preamble to for terms and conditions related to Non-Emergency Hospital In-Patient Services.
See General Preamble to for rules regarding emergency calls and other special visits to in-patients.
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