C444 – 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. The 'C' prefix indicates this service is for a non-emergency in-patient in an acute care hospital. As per , an admission assessment may be claimed as a specific re-assessment if the admitting physician has previously assessed the patient for the same presenting illness within 90 days of the admission assessment.
When to Use
- Use C444 when you are the admitting physician and have already assessed the patient for the same presenting illness in your office within the 90 days prior to the hospital admission.
- Use C444 for subsequent inpatient medical re-assessments when a full history and physical examination of one or more systems is required, provided you have not exceeded the two-per-year limit for non-admission related re-assessments.
- Use C444 instead of a consultation code (C000 series) when you are providing ongoing inpatient care for a patient you have previously assessed for the same condition.
Common Pitfalls
- Claiming C444 for a patient you have not personally assessed within the last 90 days for the same illness, which will trigger a rejection or audit recovery if billed as an admission assessment.
- Exceeding the limit of two C444 claims per patient per 12-month period for non-admission related visits, which results in an automatic payment adjustment to a lower assessment fee.
- Failing to document a complete physical examination of one or more systems, as C444 requires a higher level of clinical effort than a simple follow-up visit (C445).
Billing Tips
- Ensure you append the C101 premium if the C444 assessment is performed while the patient is in the ICU or CCU, provided no other fee-for-service code is claimed for that visit.
- Clearly document the date of your previous office assessment for the same illness in the hospital chart to support the use of C444 as an admission assessment under GP40 rules.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
In addition to the <commonElements> of all insured services (see -), all assessments must include the <specificElements> outlined in , including a direct physical encounter, taking a patient history, and performing a physical examination.
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