C341 – Complex medical specific re-assessment
OHIP Surgical Procedures Code — RADIATION ONCOLOGY (34) · 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. 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. This service is for non-emergency hospital in-patients. As an assessment, it includes the specific elements described in , such as a direct physical encounter, history taking, examination, making arrangements for related care, and discussion with the patient.
When to Use
- Use C341 for a non-emergency hospital in-patient requiring a complex re-assessment due to the obscurity or severity of their condition, provided a written report is sent to the primary care physician.
- Select C341 over A341 when the patient is an in-patient and the clinical complexity necessitates a more comprehensive review than a standard re-assessment.
Common Pitfalls
- Failure to send a written report to the primary care physician will trigger an automatic adjustment to a lower assessment fee.
- Exceeding the limit of 4 combined medical specific assessments and complex re-assessments per patient per physician per 12-month period will result in payment reduction.
- Billing C341 for emergency department patients or emergency hospital visits is incorrect; these scenarios require an 'A' prefix code combined with a Special Visit Premium.
Billing Tips
- Ensure your documentation explicitly justifies the 'complexity, obscurity, or seriousness' of the condition to support the use of the 'complex' code over a standard assessment.
- Always link your written report to the primary care physician in the patient's chart to ensure you meet the mandatory documentation requirement for audit purposes.
Effective: June 1, 2025
A. Consultations and Visits
RADIATION ONCOLOGY (34)
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.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.