1What Is the C064 OHIP Code?
What is C064?
C064 is an OHIP billing code specifically for the re-assessment of orthopedic conditions. It is used when a specialized re-evaluation of a hospital in-patient is necessary due to developments such as monitoring a limb after a cast or reduction or when there is a change in neurovascular status.
Commonly missed because of its specific eligibility criteria, C064 ensures that the re-assessment includes a comprehensive history and physical examination pertinent to one or more systems that may affect the condition under observation.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A063 | A063 Specific assessment | As needed | Initial specific assessment in the Orthopaedic Surgery listings. |
| C063 | C063 Specific assessment | As needed | In-patient specific assessment for orthopedics. |
| A064 | A064 Partial assessment | As needed | Partial assessment for Orthopaedic Surgery patients. |
| A935 | A935 Special surgical consultation | As needed | Comprehensive orthopedic surgical consultation. |
3Eligibility Requirements
Eligibility Requirements
- Frequency Limitation: C064 is allowed for up to two specific re-assessments per patient by the same physician in a consecutive 12-month period, unless rendered for hospital admissions.
- Documentation: Services must include a detailed history and relevant examination of the problem or system involved.
- Virtual Care: Eligible for virtual delivery as C064A, only when conducted via video; telephone re-assessments are not billable under this code.
- Surgical Context: Not eligible for billing as part of a surgical benefit unless it qualifies as the major pre-operative visit.
Ensure detailed time documentation in the medical record, noting when the assessment began and ended.
4What Your Clinical Note Must Show
To ensure appropriate billing for C064, the medical records must include:
- A complete, relevant history and physical examination findings.
- Timing of service delivery marked with start and end times.
- Reason for the re-assessment and any new clinical findings.
5Weak vs. Strong Note Examples
The strong note effectively documents a comprehensive re-assessment, giving specific details about the physical examination and any changes, whereas the weak note lacks the necessary detail and specificity.
Re-assessed limb. No changes. Follow up advised.
Re-assessment conducted on patient’s left lower limb post-casting. Detailed neurovascular exam performed showing unchanged distal pulses but improved capillary refill time. Discussed follow-up plan thoroughly.
- Complete relevant history and exam of lower limb documented.
- Clear detailing of findings and clinical plan in place.
- Precise timestamps indicating assessment duration.
