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C813
C813 – Midwife or Aboriginal Midwife-Requested Assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This service is a non-emergency assessment for a hospital in-patient, typically a mother or newborn, following a request from a midwife or Aboriginal midwife. It is subject to the same conditions as A813, which is the equivalent assessment performed in an out-of-hospital setting. Unlike the special version of this assessment (C815), this service does not have a minimum time requirement.
When to Use
- Use C813 for a non-emergency assessment of a mother or newborn in a hospital setting when the request originates from a midwife or Aboriginal midwife.
- Select C813 when the clinical scenario does not meet the complexity or time requirements of C815, as C813 has no minimum time threshold.
Common Pitfalls
- Billing C813 in addition to another assessment code for the same patient during the same hospital visit will result in a rejection, as only one assessment is payable per visit.
- Attempting to claim C813 for an emergency assessment is an error; ensure the clinical documentation supports the non-emergency nature of the request.
Billing Tips
- Always append the C101 premium if the assessment is performed specifically within an Intensive Care Unit (ICU) or Coronary Care Unit (CCU) setting.
- Ensure the referring midwife's name and registration number are clearly documented in the patient record to satisfy the mandatory referral requirement for this code.
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