C484 – 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 to a non-emergency hospital in-patient. As defined in the Schedule of Benefits on page , this service requires a full, relevant history and physical examination of one or more systems. It is distinguished from a medical specific assessment by not requiring a complete new history. An admission assessment may be claimed as a medical specific re-assessment if the admitting physician has previously assessed the patient for the same illness within 90 days of admission ().
When to Use
- Use C484 for a subsequent hospital visit where you perform a focused physical exam and history on one or more systems, rather than a full comprehensive assessment.
- Use C484 when admitting a patient for the same illness for which you provided a consultation or assessment within the previous 90 days, as per GP40.
- Use C484 for a specialist re-assessment of a non-emergency inpatient when the patient's condition requires a documented physical exam that exceeds the scope of a standard subsequent visit (C482).
Common Pitfalls
- Billing C484 more than twice in a 12-month period will trigger an automatic payment adjustment to a lower assessment fee.
- Claiming C484 for a routine daily visit that lacks a documented, relevant physical examination of at least one system will lead to recovery upon audit.
- Confusing C484 with C483 (Medical Specific Assessment), which requires a complete new history and is intended for more complex or new clinical problems.
Billing Tips
- Ensure your documentation explicitly notes the 'relevant history' and the specific systems examined to satisfy the GP23 requirement for a re-assessment.
- If the patient is in an ICU or CCU, remember to append the C101 premium to the C484 claim to capture the additional institutional fee.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
As per , an appropriate medical record must be maintained to establish that the service was medically necessary and rendered.
The medical record must document a full, relevant history and physical examination of one or more systems, as required for a medical specific re-assessment ().
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