C463 – Infectious disease medical specific assessment - non-emergency hospital in-patient
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A medical specific assessment rendered by an Infectious Disease (46) specialist for a non-emergency hospital in-patient. A medical specific assessment 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. The 'C' prefix indicates the service is for a non-emergency hospital in-patient (, ).
When to Use
- Use C463 for a non-emergency inpatient follow-up assessment when you are the primary Infectious Disease consultant managing a patient's ongoing infection.
- Use C463 when performing a subsequent inpatient assessment that meets the 'medical specific assessment' criteria, rather than a lower-valued supportive care code like C465.
Common Pitfalls
- Billing C463 on the same day as a consultation (C460) for the same patient; only the consultation is payable.
- Failing to document a detailed physical examination of the relevant systems, which is a mandatory requirement for the 'medical specific assessment' definition compared to simpler visit codes.
- Attempting to claim C463 for patients in the Emergency Department; this code is strictly for admitted hospital inpatients.
Billing Tips
- If the patient is located in an ICU or CCU, ensure you append the C101 premium to your C463 claim to capture the additional 9.10 flat fee.
- Ensure your documentation explicitly justifies the 'medical specific' nature of the visit to differentiate it from a routine supportive care visit (C465) during audit reviews.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments, Hospital and Institutional Consultations and Assessments
A direct physical encounter with the patient is required, including taking a patient history and performing a physical examination ().
The record must document a full history of the presenting complaint and a detailed examination of the affected part(s), region(s), or system(s) ().
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