C314 – Medical specific re-assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A medical specific re-assessment is a service rendered by a specialist for a non-emergency hospital in-patient. As defined in the Schedule on page , it requires a full, relevant history and physical examination of one or more systems. As outlined on page , this service may constitute a hospital admission assessment if the admitting physician has previously assessed the patient for the same presenting illness within 90 days of the admission assessment.
When to Use
- Use C314 when you are the admitting specialist and have already assessed the patient for the same presenting illness within the previous 90 days, effectively replacing the need for a full admission assessment code.
- Use C314 for a non-emergency hospital in-patient when performing a full, relevant history and physical examination of one or more systems that does not qualify as a subsequent visit (C312) or a more complex assessment.
- Use C314 when a surgical specialist performs an admission assessment for a patient they previously assessed in the office for the same surgical condition.
Common Pitfalls
- Billing C314 in conjunction with any special visit premium will result in a rejection; you must use the A-prefix equivalent (A314) if a premium is applicable.
- Exceeding the limit of two C314 services per patient per physician per 12-month period will trigger an automatic payment adjustment to a lower assessment fee.
- Confusing C314 with C312 (subsequent visit); C314 requires a more comprehensive history and physical examination than the standard daily follow-up.
Billing Tips
- If you are working in an ICU or CCU, you can add the C101 premium to C314, provided no other separate fee is payable for the service.
- Ensure your documentation explicitly states the 'relevant history and physical examination' performed, as this is the primary audit requirement for justifying the C314 fee over a standard visit.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
A full, relevant history and physical examination of one or more systems must be documented in the patient's medical record.
As outlined on page , admission assessments are deemed to be a specific re-assessment or medical specific re-assessment under either of the following circumstances: - for those procedures prefixed with a 'Z' or noted as an IOP, by a surgical specialist who has assessed the patient prior to admission in respect of the same illness; or - for those patients who have been assessed by a physician and subsequently admitted to the hospital for the same illness by the same physician.
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