C604 – Cardiology medical specific re-assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A medical specific re-assessment rendered by a specialist in Cardiology (specialty 60) for a non-emergency acute care hospital in-patient. According to , this service requires a full, relevant history and physical examination of one or more part(s), region(s), or system(s). 'C' prefix codes are designated for non-emergency in-patient services in an acute care hospital, as specified in . The service includes all the specific elements of an assessment () and the common elements of all insured services (, ).
When to Use
- Use C604 for a subsequent daily hospital visit when you have already performed the initial consultation (C600) for the same admission.
- Use this code for a medical specific re-assessment when managing an inpatient with heart failure (diagnosis 428) who requires a focused physical exam of the cardiovascular system.
Common Pitfalls
- Billing C604 more than twice in a 12-month period per patient will trigger an automatic payment adjustment to a lower assessment fee.
- Claiming C604 alongside psychotherapy or psychiatric services on the same day will result in rejection unless you document distinct, unrelated diagnoses for each service.
Billing Tips
- Always append the C101 premium when the re-assessment occurs within an ICU or CCU setting to capture the additional flat fee.
- Ensure your documentation explicitly records the physical examination findings of the relevant systems to satisfy the GP23 requirement for a 'specific re-assessment'.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
All insured services must be documented in appropriate records that establish the service was provided, is the service for which the account is submitted, and was medically necessary ().
Claims submission instructions: Submit claims with diagnostic code 428.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.