1What Is the C054 OHIP Code?
What is C054?
The C054 billing code represents a medical specific re-assessment used by specialists in Preventive Medicine particularly in non-emergency hospital in-patient settings. Typically, this is utilized in situations like communicable disease investigations, where specialist re-evaluations focus on elements such as exposure and control measures, rather than broad system assessments.
Due to its specialized use in public health, it is essential that physicians document the specific focus of the re-assessment to distinguish it from general assessments, ensuring accurate billing within the OHIP framework.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A053 | Medical specific assessment | Two per patient per year | Used for comprehensive initial assessments in Community Medicine. |
| C053 | Medical specific assessment | Two per patient per year | Applies to hospital in-patient initial assessments. |
| W054 | General re-assessment of patient in nursing home | As per care needs and assessment plans | Applies to routine checks under the Nursing Homes Act. |
| A051 | Complex medical specific re-assessment | As clinically required | For complex reassessments surpassing regular re-assessment criteria. |
3Eligibility Requirements
Eligibility for C054
The C054 code is applicable for medical specific re-assessments in non-emergency hospital in-patient settings for Community Medicine. Each physician can bill a patient twice per consecutive 12-month period, except when associated with hospital admissions. Time spent must be recorded precisely, including start and end times in the patient's medical record, to qualify for billing under C054. Importantly, this code can be rendered virtually; however, it must be done via video calls only, as telephone consultations are not eligible.
4What Your Clinical Note Must Show
To bill C054, ensure the following are documented:
- Patient's name, health number, and relevant demographics.
- Start and end times of the assessment service.
- A comprehensive history and physical examination of one or more relevant systems as part of the reassessment.
- Specific focus of the reassessment in the context of preventive medicine.
5Weak vs. Strong Note Examples
The strong note succeeds because it provides detailed information relevant to the Disease Control focus, with clear start and end times and specific documentation of the systems reviewed. The weak note lacks the specificity required for necessity within public health monitoring contexts.
Patient complained of fever.
General check-up done, advised rest.
Patient under investigation for an outbreak.
Reviewed exposure history specific to recent communicable disease incidence.
Conducted targeted physical examination focusing on symptoms aligning with the outbreak disease.
- Start time: 14:00, End time: 14:45
- Documented specific measures for exposure control and patient management.
