C471 – 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 because of the complexity, obscurity, or seriousness of the patient's condition and includes all the requirements of a medical specific re-assessment. As defined in the Schedule of Benefits (), a medical specific re-assessment requires a full, relevant history and physical examination of one or more systems. 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 (). The 'C' prefix indicates this service is for non-emergency hospital in-patients ().
When to Use
- Use C471 for a non-emergency hospital inpatient who requires a comprehensive re-assessment due to a significant change in clinical status or a complex diagnostic dilemma.
- Select this code when managing a patient with multi-system comorbidities where the complexity of the condition necessitates a full history and physical examination beyond a standard daily progress note.
Common Pitfalls
- Failure to send a formal written report to the patient's primary care physician will trigger an automatic payment reduction to a lower assessment fee.
- Exceeding the combined limit of 4 services per 12-month period when aggregated with C473 will result in automatic adjustment to a lesser fee.
- Billing C471 in conjunction with special visit premiums is prohibited; use an 'A' prefix code if a special visit premium is required.
Billing Tips
- Ensure the written report to the primary care physician is dated and clearly outlines your findings and recommendations to satisfy the mandatory documentation requirement.
- Track your annual count of C471 and C473 services carefully, as the Ministry applies a strict combined limit of 4 per patient per physician per 12-month period.
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 an assessment, this service requires documentation of a direct physical encounter with the patient, including a patient history and physical examination.
The medical record must contain all required information to establish that an insured service was provided, was medically necessary, and is the service for which the account is submitted.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.