C464 – 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 for a non-emergency hospital in-patient. As per , it is a service rendered by specialists and requires a full, relevant history and physical examination of one or more systems. It includes all the services listed for a general assessment, with the exception of the patient's history, which need not include all the details already obtained in the original assessment. This service also includes the specific elements of assessments outlined in and the common elements of all insured services outlined in and . When an admitting physician has previously assessed the patient for the same presenting illness within 90 days of the admission assessment, this service may constitute the admission assessment as per .
When to Use
- Use C464 for a comprehensive re-assessment of a hospitalized patient when a significant change in clinical status requires a new, detailed physical exam of one or more systems.
- Use this code when performing a scheduled follow-up assessment on an in-patient where the complexity exceeds a standard subsequent visit (C002) but does not meet the requirements for a full consultation (C462).
Common Pitfalls
- Billing C464 for routine daily follow-up visits; this code is intended for complex re-assessments, not standard ward rounds.
- Attempting to claim Special Visit Premiums with C464; these must be billed using the 'A' prefix equivalent (A464) to be eligible for premium payments.
- Exceeding the two-per-year limit for non-admission-related re-assessments, which triggers an automatic reduction to a lower assessment fee.
Billing Tips
- Ensure documentation explicitly reflects a full, relevant physical examination of one or more systems to justify the higher fee compared to a standard subsequent visit code.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
A service is only eligible for payment to the Supervising Physician when the medical record of the patient(s) identifies the Supervising Physician, the Medical Trainee and level of training, the description of the insured service performed by the Medical Trainee, and patient consent to the Supervision of services of a Medical Trainee. The Supervising Physician must have signed off on the service rendered or the Medical Trainee has documented the date and time of discussion with the Supervising Physician ().
The medical record must contain a full, relevant history and physical examination of one or more systems ().
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