C441 – Complex medical specific re-assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A complex medical specific re-assessment is a re-assessment of a patient by a Medical Oncology specialist because of the complexity, obscurity, or seriousness of the patient's condition and includes all the requirements of a medical specific re-assessment. As per , the physician must report his/her findings, opinions, or recommendations in writing to the patient's primary care physician or the amount payable for the service will be adjusted to a lesser assessment fee. As per , this service includes the following specific elements: a direct physical encounter with the patient including taking a patient history and performing a physical examination; other inquiry to arrive at an opinion as to the nature of the patient's condition; performing any procedures during the same encounter unless separately billable; making arrangements for any related assessments, procedures or therapy, and/or interpreting results; making arrangements for follow-up care; discussion with, and providing advice and information to the patient or representative; and, when medically indicated, monitoring the condition of the patient and intervening, until the next insured service is provided. This code applies to non-emergency hospital in-patient services.
When to Use
- Use C441 for a complex, obscure, or serious oncology re-assessment of an existing hospital in-patient where a detailed written report to the primary care physician is generated.
- Select C441 when managing a patient with multi-system complications or treatment-refractory disease that requires a comprehensive re-evaluation of the oncology care plan.
Common Pitfalls
- Failing to send a written report to the primary care physician will trigger an automatic adjustment to a lower-valued assessment fee.
- Exceeding the combined limit of 4 services per 12-month period for C441 and C443 will result in payment adjustments for the excess claims.
- Billing C441 in conjunction with other assessment codes for the same patient on the same day will result in the rejection of all but one assessment.
Billing Tips
- Ensure your documentation clearly justifies the 'complexity, obscurity, or seriousness' of the patient's condition to satisfy audit requirements for the higher fee.
- If the patient is in the ICU or CCU, remember to add the C101 premium to your C441 claim to maximize the encounter value.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
The physician must report his/her findings, opinions, or recommendations in writing to the patient's primary care physician.
As per , all insured services must be documented in appropriate records to establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
See to for rules on Non-Emergency Hospital In-patient Services.
For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable - see to .
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