C443 – Medical specific assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A medical specific assessment for a non-emergency hospital in-patient, rendered by a specialist in Medical Oncology. A medical 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, as defined in the Schedule of Benefits (). The 'C' prefix indicates the service is for an acute care hospital non-emergency in-patient ().
When to Use
- Use C443 for a scheduled, non-urgent medical assessment of an oncology inpatient where a full history and detailed system examination are required to manage a specific oncological complication.
- Use this code when performing a follow-up assessment for a patient admitted under your service for chemotherapy or radiotherapy side-effect management that does not meet the criteria for a consultation (C441) or a subsequent visit (C446).
Common Pitfalls
- Billing C443 on the same day as a psychotherapy or psychiatric care service by the same physician will result in rejection unless a distinct diagnosis is documented for each service.
- Attempting to bill C443 after a patient transfer from another physician for the same admission will be rejected, as only one admission assessment is payable per patient per hospital stay.
- Billing C443 alongside special visit premiums is a common error; if the visit is an emergency or requires a special trip, you must use A443 instead.
Billing Tips
- If the patient is located in an ICU or CCU, ensure you append the C101 premium to C443 to capture the additional value for the intensive care setting.
- Ensure your documentation explicitly reflects a 'full history' and 'detailed examination' to satisfy the specific requirements of the Schedule of Benefits, as this code is subject to frequency limit audits.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments, Hospital and Institutional Consultations and Assessments
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.
See General Preamble to for rules on Non-Emergency Hospital In-Patient Services.
For emergency calls and other special visits to in-patients, use General Listings (A-prefix codes) and Premiums when applicable - see General Preamble to .
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