C903 – Pre-dental/pre-operative general assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A pre-dental/pre-operative general assessment for a non-emergency hospital in-patient, as indicated by the 'C' prefix. This service includes a full history and a comprehensive examination of all body parts and systems, as defined for a general assessment on . It is subject to a maximum of two services per 12-month period. This assessment is eligible for a 15% age-based premium for patients 65 years of age and older ().
When to Use
- Use C903 when performing a comprehensive pre-operative general assessment for an elective surgery patient already admitted to a non-emergency hospital setting.
- Use C903 for a pre-dental clearance assessment in a hospital inpatient, provided the service meets the full history and physical requirements defined in GP21.
Common Pitfalls
- Billing C903 within 30 days of an admission assessment for the same patient by the same physician will trigger a rejection under GP41 rules.
- Failing to document a complete functional inquiry into all body systems, which is a mandatory requirement for a general assessment, often leads to audit recovery.
- Exceeding the maximum of two services per 12-month period will result in automatic claim rejection.
Billing Tips
- Ensure the 15% age-based premium is applied for patients 65 and older, as this is not always automatically calculated by all billing software.
- If the patient is admitted for the surgery within 30 days of the C903, ensure the admission note is billed as a subsequent visit rather than a new admission assessment to avoid GP41 conflicts.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
As a general assessment, this service requires a full history (the elements of which must include a history of the presenting complaint, family medical history, past medical history, social history, and a functional inquiry into all body parts and systems), and, except for breast, genital or rectal examination where not medically indicated or refused, an examination of all body parts and systems, and may include a detailed examination of one or more parts or systems.
maximum of 2 per 12 month period
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