C680 – Initial Assessment – Substance Abuse
OHIP Surgical Procedures Code — Family Practice & Practice in General (00) · Schedule of Benefits
An initial assessment for a patient with substance abuse issues, rendered as a non-emergency in-patient service in an acute care hospital, as indicated by the 'C' prefix (see on ). This service is subject to the same conditions as A680. Payment Requirements: - A DSM diagnosis must be recorded in relation to each problematic substance in the patient's permanent medical record. - Relevant information obtained in the provision of all elements of the service must be recorded in the medical record. Failure to meet these documentation requirements will result in the amount payable for the service being adjusted to a lesser assessment fee.
When to Use
- Use C680 for the initial comprehensive assessment of a patient admitted to an acute care hospital specifically for substance abuse management.
- Choose C680 over a standard hospital visit code (C002) when the primary purpose of the encounter is the formal diagnostic and treatment formulation for substance dependence.
Common Pitfalls
- Failing to explicitly document a DSM-5 diagnosis for every substance identified as problematic will trigger an automatic adjustment to a lower assessment fee.
- Billing C680 for a patient who is already under your care for the same substance abuse episode in the same hospital admission is a common audit trigger for duplicate billing.
- Omitting the psychosocial history or the review of treatment options in the chart note will result in a clawback, as these are mandatory elements of the C680 service definition.
Billing Tips
- Ensure your documentation template includes a dedicated section for DSM-5 diagnostic criteria to satisfy the specific payment requirements for this code.
- If the patient has multiple substance dependencies, list each one with its corresponding DSM diagnosis in the assessment note to justify the full fee.
Effective: April 1, 2026
Consultations and Visits
Family Practice & Practice in General (00)
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
A DSM diagnosis must be recorded in relation to each problematic substance in the patient's permanent medical record.
Relevant information obtained in the provision of all elements of the service must be recorded in the medical record.
This service is subject to the same conditions as A680.
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