C311 – Complex medical specific re-assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A complex medical specific re-assessment is a re-assessment of a patient because of the complexity, obscurity, or seriousness of the patient's condition and includes all the requirements of a medical specific re-assessment. A medical specific re-assessment requires a full, relevant history and physical examination of one or more systems. The physician must report his/her findings, opinions, or recommendations in writing to the patient's primary care physician or the amount payable for the service will be adjusted to a lesser assessment fee. The 'C' prefix indicates this service is for non-emergency hospital in-patients.
When to Use
- Use C311 when performing a comprehensive, multi-system re-assessment of a hospitalized patient whose condition has become significantly more complex or obscure than at the time of the initial consultation.
- Use this code for a serious, non-emergency in-patient re-evaluation that requires a detailed written report to the referring primary care physician, differentiating it from a standard subsequent visit (C122).
Common Pitfalls
- Failing to send a formal written report to the primary care physician will result in an automatic downward adjustment to a standard subsequent visit fee (C122).
- Billing C311 for routine daily hospital rounds is an audit risk; it is intended for complex, specific re-assessments, not as a substitute for daily C122 visits.
- Claiming C311 alongside critical care or supportive care codes is often rejected; ensure the complexity of the visit justifies the specific assessment fee over bundled care codes.
Billing Tips
- Ensure your clinical note explicitly states 'Complex Medical Specific Re-assessment' and documents a full, relevant history and physical exam to meet the specific requirements of the Schedule of Benefits.
- If the patient is in the ICU or CCU, remember to append the C101 premium to the C311 claim to maximize the value of the complex assessment.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
The physician must report his/her findings, opinions, or recommendations in writing to the patient's primary care physician.
As a re-assessment, the medical record must document a full, relevant history and physical examination of one or more systems.
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 .
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.