C413 – Medical specific assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
`C413` is a medical specific assessment rendered by a specialist in Gastroenterology (specialty 41) for a non-emergency acute care hospital in-patient, as designated by the 'C' prefix . As per , this service 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. In addition to the common elements, it includes all specific elements of assessments outlined in , such as a direct physical encounter, making arrangements for related procedures and follow-up care, and discussing findings with the patient.
When to Use
- Use C413 for a standard inpatient follow-up assessment by a Gastroenterologist when the patient's condition requires a detailed review of systems and physical examination.
- Use C413 when managing an inpatient with a new gastrointestinal issue that requires a specific diagnostic opinion, provided it is not a formal consultation (C418).
Common Pitfalls
- Billing C413 alongside a Special Visit Premium (e.g., K963) will result in a rejection; you must use the 'A' prefix equivalent (A413) if a premium is required.
- Claiming C413 for a patient who had a pre-operative assessment by you within the previous 30 days for the same elective admission will trigger an automatic rejection under GP41.
- Attempting to bill C413 in addition to a procedural fee that includes an assessment component will lead to a payment adjustment or rejection for duplicate billing.
Billing Tips
- If you are attending the patient in an ICU or CCU, ensure you append the C101 premium to the C413 claim to capture the additional value for the institutional setting.
- Always document the specific physical examination findings and the plan for follow-up care to satisfy the GP23 requirements for a 'medical specific assessment' during an audit.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.