C343 – Medical specific assessment
OHIP Surgical Procedures Code — RADIATION ONCOLOGY (34) · Schedule of Benefits
A medical specific assessment rendered to a non-emergency in-patient of an acute care hospital. As defined in the Schedule of Benefits (), this service is rendered by a specialist and 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. The 'C' prefix designates this service for non-emergency in-patient services in an acute care hospital ().
When to Use
- Use C343 for a non-emergency, medically necessary assessment of an acute care in-patient when a full history and detailed examination are required to manage a radiation oncology-related condition.
- Use C343 when performing a routine follow-up or interval assessment on an in-patient that exceeds the scope of a simple hospital visit but does not meet the criteria for a formal consultation.
Common Pitfalls
- Billing C343 alongside E078 is a common error; E078 is strictly for office or out-patient settings and is ineligible for in-patient services.
- Failing to document a 'detailed examination' of the specific system or region involved will lead to recovery during an audit, as C343 requires more than a cursory review of systems.
- Attempting to claim C343 with psychotherapy or other time-based codes on the same day without a distinct, separate diagnosis will result in automatic rejection.
Billing Tips
- Ensure the clinical note explicitly links the assessment to the patient's in-patient status and the specific radiation oncology diagnosis to satisfy the 'medically necessary' requirement.
- If the visit is non-elective and requires a special trip to the hospital, remember to attach the appropriate Special Visit Premium (e.g., C990-C996) to maximize the claim value.
Effective: June 1, 2025
A. Consultations and Visits
RADIATION ONCOLOGY (34)
Assessment
Assessments, Hospital and Institutional Consultations and Assessments
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 must be documented. ()
The medical record must establish that an insured service was provided, the service claimed is the service that was rendered, and the service was medically necessary. ()
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 .
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