C270 – Complex infectious disease assessment (In-patient)
OHIP Surgical Procedures Code · Schedule of Benefits
An assessment for the ongoing management of specific complex infectious diseases requiring the continuing management by an infectious disease specialist, where the visit requires a minimum of 20 minutes in direct contact with the patient.
When to Use
- Use for the ongoing management of a patient with an active MDR organism (e.g., VRE or CPE) who requires complex IV antibiotic titration and clinical monitoring during an inpatient stay.
- Use for the management of active pulmonary tuberculosis requiring specialist oversight of multi-drug regimens and monitoring for treatment-related toxicities.
- Use for deep-seated fungal infections (e.g., invasive candidiasis or dimorphic fungi) where the complexity of the systemic infection necessitates a minimum of 20 minutes of direct specialist contact.
Common Pitfalls
- Billing C270 for latent tuberculosis infection, which is explicitly excluded from the eligibility criteria.
- Failing to document specific start and stop times in the chart, which triggers an automatic adjustment to a lower-valued assessment code like C463 or C464 during audit.
- Including time spent on separately billable procedures or administrative tasks in the 20-minute direct contact requirement, leading to non-compliance with the time-based mandate.
Billing Tips
- If performing the admission assessment as the MRP, ensure E082 is appended to capture the 30% premium, as C270 is eligible for this add-on unlike standard chronic disease premiums.
- Maintain a clear log of the 20-minute direct patient contact time separate from any other interventions performed on the same day to ensure the claim withstands Ministry review.
Effective: April 1, 2026
Hospital In-Patient
Assessment
Must include all elements of a 'specific assessment' as defined in (history, physical exam, inquiry, etc.).
Minimum of 20 minutes in direct contact with the patient, exclusive of time spent on other separately billable interventions.
The start and stop times must be recorded in the patient’s permanent medical record.
The complexity of the condition must require continuing management by an infectious disease specialist.
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