All codes
C713
C713 – Medical Specific Assessment
OHIP Surgical Procedures Code — Critical Care Medicine (11) · Schedule of Benefits
A medical specific assessment rendered by a Critical Care Medicine specialist for a hospital in-patient. The 'C' prefix indicates this service is for non-emergency in-patient services in an acute care hospital. As per the definition on page , a medical specific assessment requires a full history of the presenting complaint and a detailed examination of the affected part(s), region(s), or system(s) to make a diagnosis, exclude disease, or assess function. It includes all specific elements of an assessment as outlined on page .
When to Use
- Use C713 for a scheduled, non-emergency medical specific assessment of an established ICU or ward inpatient by a Critical Care specialist.
- Use this code for a follow-up assessment when the patient's clinical status changes, requiring a new history and detailed examination of a specific system.
Common Pitfalls
- Claiming C713 for an emergency assessment; you must use A713 if the service requires a special visit premium, as 'C' prefix codes are ineligible for these premiums.
- Billing C713 in addition to a daily ICU management fee if the assessment is considered part of the global care package, leading to automatic rejections.
- Submitting C713 for an admission assessment performed in the ER; if the patient is admitted, the ER assessment is the admission assessment and C713 is not payable.
Billing Tips
- Always append the C101 premium when performing this assessment specifically within an ICU or CCU setting to maximize the claim value.
- If the patient meets trauma criteria, ensure the Injury Severity Score (ISS) is clearly documented in the chart to support the E420 premium addition.
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