1What Is the C073 OHIP Code?
C073 pertains to a medical specific assessment conducted by a geriatrician while a patient is hospitalized. This code addresses scenarios such as assessing a patient's capacity, evaluating a fall in the hospital, or reviewing a single high-risk medication. By focusing on comprehensive evaluations, this code ensures that elderly patients, or those assessed for dementia, receive the appropriate level of care.
The medical specific assessment requires a complete history-taking of the presenting complaint and a thorough physical examination of the relevant bodily regions. It is often missed when either the documentation does not entirely meet OHIP's comprehensive requirements, or the patient scenario doesn't clearly qualify, limiting the applicable frequency within the billing year.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A073 | Medical specific assessment | once yearly unless conditions are met | Out-patient equivalent to C073, for use outside the hospital setting. |
| A071 | Complex medical specific re-assessment | determined by case specifics | Used for more involved re-assessments in geriatrics. |
| A074 | Medical specific re-assessment | upon eligibility | Follows a specific assessment applicable to evolving cases. |
| C071 | Complex medical specific re-assessment | determined by case specifics | Indicates a more comprehensive review in hospital settings. |
3Eligibility Requirements
To bill C073, the following eligibility requirements must be satisfied:
- The patient must be at least 65 years of age, or the assessment must pertain to a diagnosis of dementia, regardless of the patient's age.
- This assessment is rendered in a non-emergency hospital in-patient setting specifically within Geriatrics services.
- C073 services may only be performed and reimbursed once per patient per physician in a 12-month period unless the patient either presents with an unrelated diagnosis on a subsequent visit or 90 days have passed since the previous assessment, and the re-assessment is connected to a hospital admission.
- Virtual delivery of the service is permitted exclusively via video call, as opposed to telephone, and should be billed under C073A.
- Time spent on the service must be documented, noting when the patient's assessment started and ended.
4What Your Clinical Note Must Show
Complete and detailed records must be kept to justify the billing of C073, including:
- A fully documented history of the presenting complaint.
- Detailed examination notes of affected body parts or systems.
- Accurate time log indicating the start and end times of the service.
- Clear diagnosis or differential diagnosis derived from the assessment.
5Weak vs. Strong Note Examples
The strong note succeeds due to its detailed clinical information and precise time logging, clearly satisfying OHIP's requirements, while the weak note lacks specificity and crucial documentation elements.
Conducted assessment. Patient reports difficulty with a medication. Examined patient briefly and gave advice.
Conducted medical specific assessment as requested by the ward team for cognitive capacity concerns. Patient, aged 68, presented with increased confusion, possibly related to benzodiazepine use.
A complete history was obtained to understand the context of medication use and associated confusion. A detailed cognitive and mental status examination was performed, revealing deficits consistent with benzodiazepine effect.
Assessment start: 14:00, end: 15:20.
- Documented comprehensive history with all relevant past medical history
- Thorough examination of patient was performed
- Time spent with patient was accurately recorded
