C473 – Medical specific assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A medical specific assessment is a service rendered by a specialist in a hospital in-patient setting. It 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 a 'C' prefix code, this service is for non-emergency hospital in-patient services.
When to Use
- Use C473 for a non-emergency, scheduled in-patient assessment when the patient does not meet the strict criteria for a full consultation (C475).
- Use C473 for the initial admission assessment when you have already performed a consultation or assessment in the ER/OPD for the same admission, as the initial service covers the admission.
- Use C473 for subsequent in-patient assessments when the patient's condition requires a detailed review of a specific system or region that exceeds the scope of a standard subsequent visit (C471).
Common Pitfalls
- Billing C473 for emergency in-patient visits; these must be billed using the corresponding 'A' prefix code (e.g., A473) plus the appropriate Special Visit Premium.
- Exceeding the 4-service limit per 12-month period, which triggers an automatic adjustment to a lower-valued assessment fee.
- Attempting to bill a second C473 during the same hospital admission; OHIP restricts payment to only one specific assessment per patient per admission.
Billing Tips
- If you are called to the hospital for an urgent, non-elective in-patient assessment, bill A473 with the applicable Special Visit Premium (Table III) instead of C473 to ensure proper compensation.
- Ensure your documentation clearly distinguishes the C473 assessment from routine daily rounds (C471) by highlighting the specific diagnostic or functional assessment performed.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
A direct physical encounter with the patient including taking a patient history and performing a physical examination.
Other inquiry (including taking a patient history), carried out to arrive at an opinion as to the nature of the patient's condition, (whether such inquiry takes place before, during or after the encounter during which the physical examination takes place) and/or follow-up care.
Discussion with, and providing advice and information, including prescribing therapy to the patient or the patient's representative, whether by telephone or otherwise.
When medically indicated, monitoring the condition of the patient and intervening, until the next insured service is provided.
The 'C' prefix indicates a service rendered as a non-emergency hospital in-patient service.
For emergency calls and other special visits to in-patients, use General Listings ('A' prefix codes) and Premiums when applicable.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.