C283 – Medical Specific Assessment
OHIP Surgical Procedures Code — Laboratory Medicine (28) · Schedule of Benefits
A medical specific assessment is a service rendered by a specialist that requires a full history of the presenting complaint and a detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis, exclude disease, and/or assess function. The C prefix indicates this service is for a non-emergency in-patient in an acute care hospital. The service includes the specific elements of assessments as defined in .
When to Use
- Use C283 for a scheduled, non-emergency follow-up assessment of an in-patient where a detailed examination of a specific system is required.
- Use C283 when managing a patient's ongoing hospital care that does not meet the complexity criteria for a C285 or C286 assessment.
Common Pitfalls
- Billing C283 for an emergency or urgent in-patient visit, which must be billed using the A283 code plus applicable premiums.
- Exceeding the frequency limit of 4 assessments per 12 months in combination with complex re-assessments, which triggers an automatic fee adjustment.
- Billing C283 when the service provided was a consultation, which requires a formal referral and the use of a C-prefix consultation code.
Billing Tips
- Ensure the clinical note explicitly details the history of the presenting complaint and the specific physical examination findings to justify the 'specific assessment' requirement.
- Monitor your annual frequency counts for C283 and C285 to avoid the automatic payment reduction applied when exceeding the 4-assessment limit.
Effective: June 1, 2025
Consultations and Visits
Laboratory Medicine (28)
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
A medical 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. ()
All assessments require a direct physical encounter with the patient including taking a patient history and performing a physical examination. ()
All insured services must be documented in appropriate records that establish the service was provided, is the service for which the account is submitted, and was medically necessary. ()
See General Preamble to for rules regarding non-emergency hospital in-patient services.
For emergency calls and other special visits to in-patients, use General Listings (A283) and Premiums when applicable - see General Preamble to .
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