C354 – Specific re-assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
C354 is a specific re-assessment for a non-emergency, acute care hospital in-patient, as indicated by the 'C' prefix (:26). According to the Schedule of Benefits, a specific re-assessment is a service rendered by a specialist that requires a full, relevant history and physical examination of one or more systems (:37). This service includes all the specific elements of an assessment as defined in :29, such as: - A direct physical encounter including patient history and physical examination. - Making arrangements for related assessments, procedures, or therapy. - Discussion with and providing advice to the patient or their representative. - Monitoring the patient's condition and intervening when medically indicated.
When to Use
- Use C354 for a planned, non-urgent re-assessment of an existing hospital inpatient where a full, relevant history and physical examination of one or more systems is required.
- Use this code when the patient's clinical status has changed or requires a formal review of a specific system, distinguishing it from routine daily subsequent visits like C002.
Common Pitfalls
- Billing C354 in conjunction with a Special Visit Premium will result in a rejection; you must use the corresponding 'A' prefix code (e.g., A354) if a premium is applicable.
- Attempting to bill C354 for routine daily follow-up care that does not meet the 'full, relevant history and physical' requirement will lead to audit recovery.
- Confusing C354 with C352 or C353; ensure the clinical documentation explicitly supports the 'specific re-assessment' criteria rather than a general subsequent visit.
Billing Tips
- Ensure your documentation clearly identifies the specific system(s) examined and the clinical rationale for the re-assessment to satisfy the 'full, relevant history and physical' requirement.
- You may append the C101 ICU/CCU premium to C354 if the patient is in an eligible unit and the service is not otherwise excluded by team-based care restrictions.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments, Hospital and Institutional Consultations and Assessments
Requires a full, relevant history and physical examination of one or more systems.
For emergency calls and other special visits to in-patients, use General Listings ('A' prefix codes) and Premiums when applicable (see :79 to :92).
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