C414 – Medical specific re-assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A medical specific re-assessment is a service rendered by a specialist and requires a full, relevant history and physical examination of one or more systems. As a C prefix code, this service is for a non-emergency in-patient in an acute care hospital. An admission assessment is deemed to be a medical specific re-assessment if the admitting physician has previously assessed the patient for the same presenting illness within 90 days of the admission assessment, or for those patients who have been assessed by a physician and subsequently admitted to the hospital for the same illness by the same physician (, ).
When to Use
- Use C414 when you admit a patient to hospital for the same illness for which you provided an office assessment (A414) within the preceding 90 days.
- Use C414 for a subsequent inpatient re-assessment when the patient has been previously assessed by you for the same presenting illness within the same 90-day window.
- Use C414 for non-emergency inpatient hospital visits where a full history and physical of one or more systems is required and performed.
Common Pitfalls
- Billing C414 in conjunction with a special visit premium will result in a rejection, as C-prefix codes are ineligible for these premiums.
- Exceeding the 12-month limit of two services per patient per physician will trigger an automatic adjustment to a lower assessment fee.
- Attempting to bill C414 for an emergency department encounter is incorrect; use the appropriate A-prefix code for ED services.
Billing Tips
- Ensure your documentation explicitly links the inpatient admission to the prior assessment within the 90-day window to justify the use of C414 over a standard admission assessment.
- If the patient is in an ICU or CCU, remember to append the C101 premium to the C414 claim to maximize the value of the inpatient visit.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
A full, relevant history and physical examination of one or more systems must be documented.
The medical record must contain all common elements of an insured service as per - and specific elements of assessments as per .
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.