C511 – Complex physiatry assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A complex physiatry assessment rendered to a non-emergency hospital in-patient. This service is subject to the same conditions as A511. As a 'C' prefix code, it is designated for acute care hospital non-emergency in-patient services, as per . This assessment is for patients under the care of a specialist in Physical Medicine & Rehabilitation.
When to Use
- Use C511 for a comprehensive, multi-system re-assessment of an inpatient with a complex diagnosis like spinal cord injury or stroke when the patient requires a significant change in their rehabilitation management plan.
- Select C511 when performing a complex assessment on a non-emergency inpatient in a rehabilitation hospital setting, provided the patient meets the specific diagnostic criteria for Physical Medicine & Rehabilitation.
Common Pitfalls
- Billing C511 in conjunction with a Special Visit Premium will result in an automatic rejection; use the appropriate 'A' prefix code from the General Listings if a special visit is required.
- Exceeding the annual or periodic frequency limits for C511 will trigger a payment adjustment to a lower assessment fee, as these services are subject to strict volume caps defined in the Schedule of Benefits.
Billing Tips
- Ensure the clinical documentation explicitly supports the 'complex' nature of the assessment by detailing the multi-system involvement, as this distinguishes C511 from standard follow-up assessments like C510.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
A complex physiatry assessment must include the elements of a medical specific re-assessment.
subject to the same conditions as A511
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