C904 – Pre-dental/pre-operative assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A pre-dental or pre-operative assessment rendered to a non-emergency in-patient in an acute care hospital. This service is claimed using the 'C' prefix, as defined on page , and falls under the 'Family Practice & Practice in General (00)' specialty. Per page , if this assessment is performed for an elective surgery patient, certain admission assessments (A933, C933, C003, C004) are not payable if rendered by the same physician within 30 days of admission. The service must include all specific elements of an assessment as outlined on page .
When to Use
- Use C904 when performing a formal pre-operative assessment for a non-emergency inpatient scheduled for an elective procedure.
- Use this code for a pre-dental assessment required for an inpatient prior to oral surgery or dental clearance in an acute care hospital setting.
Common Pitfalls
- Billing C904 in conjunction with A933, C933, C003, or C004 within 30 days of admission by the same physician will trigger an automatic rejection.
- Attempting to attach a Special Visit Premium to C904 is a common error; premiums are only payable with 'A' prefix assessment codes.
Billing Tips
- Ensure the documentation explicitly reflects a complete assessment as defined in GP15, as this code is frequently audited for compliance with the required physical examination elements.
Effective: September 1, 2011
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments, Hospital and Institutional Consultations and Assessments
As an assessment, this service must include the specific elements defined on page : a direct physical encounter with the patient, history taking, physical examination, and appropriate record-keeping.
All insured services must be documented in the medical record to establish that the service was provided, medically necessary, and is the service for which the account is submitted, as per page .
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