1What Is the C004 OHIP Code?
The C004 billing code is used in Ontario for general re-assessments of hospital in-patients by family physicians. This code is critical for situations where a patient's status has changed significantly during an admission, necessitating a complete clinical re-examination.
General re-assessments include all services involved in a general assessment except for obtaining a comprehensive patient history again. This makes it vital for capturing shifts in a patient's condition over longer hospital stays.
Commonly missed opportunities to use C004 arise due to misunderstanding its readiness as a reflection of patient care outside initial or emergency assessments.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A003 | General assessment | No limit specified | Comprehensive general assessment at $95.60. |
| C003 | General assessment | No limit specified | In-depth general assessment at $89.65. |
| A004 | General re-assessment | Two per year | Out-patient equivalent for general re-assessments at $39.35. |
| W004 | General re-assessment of patient in nursing home | No limit specified | Specialized for nursing home settings at $38.35. |
3Eligibility Requirements
To bill C004, family physicians must ensure they perform the re-assessment as per the Schedule of Benefits.
A general re-assessment requires undertaking all services typically covered in a general assessment, minus the full patient history recap. Note that for in-patients, these re-assessments must be constrained to two per year per patient per physician, barring cases involving hospital admissions.
Proper documentation, including clear start and end times of the service, recorded in the patient’s medical record, is essential for eligibility.
4What Your Clinical Note Must Show
To meet OHIP requirements for C004 billing, accurately record the following details in the patient's permanent medical record:
- Start and end times of the re-assessment service.
- A detailed but not redundant rundown of all procedures performed.
- Clear notes on patient status changes justifying the re-assessment.
5Weak vs. Strong Note Examples
The strong note is successful because it provides a clear rationale for the re-assessment and explicitly logs clinical findings and responses, whereas the weak note lacks detail and justification.
Re-assessed patient. No major changes. Billing C004.
Conducted a comprehensive re-assessment given the change in patient's respiratory status. Evaluated heart and lung functions, confirmed diagnosis adjustment of pneumonia progression, and adjusted treatment plan accordingly.
Service start: 10:00 AM, end: 10:40 AM.
- Recorded the rationale for re-assessment clearly.
- Included detailed changes in patient's status and subsequent medical action.
