C603 – Cardiology medical specific assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A medical specific assessment rendered by a specialist in Cardiology (60) for a non-emergency hospital in-patient. As per , this service 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, exclude disease, and/or assess function. The 'C' prefix indicates the service is for non-emergency hospital in-patient services (, ). This service can function as an admission assessment if the physician has not previously assessed the patient for the same illness within 90 days ().
When to Use
- Use C603 for the initial admission assessment of an in-patient where you have not provided a service for the same illness in the preceding 90 days.
- Use C603 for a subsequent medical specific assessment of an in-patient when the patient's clinical status changes, requiring a detailed history and examination beyond the scope of a C600 subsequent visit.
Common Pitfalls
- Billing C603 when a C600 subsequent visit is more appropriate; C603 requires a full history and detailed examination, not just a progress note.
- Failing to document the specific clinical rationale for a 'medical specific' assessment, which can lead to payment adjustments if the Ministry deems the service does not meet the complexity requirements of GP23.
- Attempting to bill C603 on the same day as a psychotherapy or counselling service without distinct, unrelated diagnoses, which triggers automatic claim rejections.
Billing Tips
- If the patient is in an ICU or CCU, ensure you append the C101 premium to the C603 claim to capture the additional facility-based complexity.
- Always verify the 90-day rule before billing C603 as an admission assessment; if you have seen the patient for the same condition within that window, the service is considered a subsequent visit (C600).
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
A full history of the presenting complaint and 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 must be documented in the patient's medical record ().
All insured services require documentation in the medical record that establishes the service was provided, the service claimed is the service rendered, and the service was medically necessary ().
See General Preamble to for rules on non-emergency hospital in-patient services.
For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable - see General Preamble to .
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