C353 – Specific assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
C353 is for a specific assessment rendered by a specialist in Urology (35) to a non-emergency hospital in-patient. As per the Schedule of Benefits (), a specific assessment 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, and/or exclude disease, and/or assess function. It is subject to the specific elements of all assessments as defined in , which includes history taking, physical examination, arranging follow-up, and providing advice to the patient.
When to Use
- Use C353 for a focused urological assessment of an inpatient when the clinical situation does not meet the complexity requirements of a consultation (C352).
- Use C353 for subsequent daily visits where a specific, focused assessment of a urological system is required, rather than routine supportive care.
- Use C353 when managing an inpatient's urological condition that is distinct from the primary reason for their current hospital admission.
Common Pitfalls
- Billing C353 when a Special Visit Premium is applicable; you must use A353 instead to avoid automatic rejection.
- Exceeding the one-per-admission limit for initial assessments, which triggers an automatic adjustment to a lower-tier assessment fee.
- Confusing C353 with C352 (Consultation); C353 is for specific assessments, whereas C352 requires a formal request from another physician and a comprehensive review.
Billing Tips
- Ensure your documentation clearly reflects the 'specific' nature of the assessment, detailing the history and physical exam of the urological system to justify the code over a routine visit.
- If the patient is in the ICU or CCU, remember to append C101 to your C353 claim to capture the additional premium.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments, Hospital and Institutional Consultations and Assessments
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