C570 – Complex respiratory assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
C570 is a complex respiratory assessment for a non-emergency hospital in-patient, subject to the same conditions as A570. The 'C' prefix indicates that this service is for non-emergency in-patient services in an acute care hospital, as defined in the General Preamble (-). This service is rendered by a specialist in Respiratory Disease (47).
When to Use
- Use C570 for a complex respiratory assessment of an admitted hospital patient with chronic respiratory failure (PaO2 <60mmHg or PaCO2 >50mmHg) when the patient is under your care.
- Use this code for the initial complex assessment of a patient with active mycobacterial tuberculosis or non-tuberculous mycobacterial disease requiring inpatient management.
- Use C570 when managing a patient with cystic fibrosis or bronchiectasis who presents with an acute exacerbation requiring specialized respiratory intervention.
Common Pitfalls
- Billing C570 more than once per 12-month period without a distinct, unrelated diagnosis or a 90-day gap will trigger an automatic adjustment to a lower assessment fee.
- Claiming C570 upon patient transfer from another physician within the same hospital is prohibited; only one consultation or assessment is eligible per admission.
- Failing to document the specific criteria for 'complex' respiratory status will lead to downgrades if the claim is audited against the requirements of A570.
Billing Tips
- If the patient is located in an ICU or CCU, ensure you append the C101 premium to the C570 claim to capture the additional fee for critical care settings.
- Ensure your documentation explicitly references the clinical indicators of respiratory failure or the specific mycobacterial diagnosis to justify the 'complex' designation over a standard hospital visit code.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
A570 must include the elements of a medical specific re-assessment, or the amount payable will be adjusted to a lesser assessment fee.
Subject to the same conditions as A570.
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