1What Is the C204 OHIP Code?
What is C204?
C204 is the OHIP billing code designated for specific re-assessments conducted by obstetricians and gynaecologists. This service involves a comprehensive re-evaluation of a hospital in-patient, usually after a significant change in the patient's condition or treatment plan. Common scenarios include post-operative follow-up for complications like bleeding, or reevaluation after altering an obstetric management plan.
Specialists use this code to ensure that changes in a patient's clinical status are thoroughly assessed and documented, aiding in effective clinical decision-making. Despite its significance, C204 is sometimes underutilized due to confusion with related assessment codes or improper documentation of time spent on the re-assessment, which is mandatory.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A203 | Specific assessment | 2 per 12 months | Initial assessment for a specific condition. |
| C203 | Specific assessment | Not specified | Specific assessment rendered by a specialist in hospital settings. |
| A204 | Partial assessment | Not specified | Out-patient equivalent for simpler assessments outside of a hospital setting. |
| A935 | Special surgical consultation | Not specified | In-depth consultation for complex surgical cases. |
3Eligibility Requirements
Eligibility for C204
C204 may only be billed by specialists in Obstetrics and Gynaecology for specific re-assessments of in-patients. It is limited to two services per patient per physician per consecutive 12-month period, with exceptions for re-assessments linked to hospital admissions.
According to the OHIP Schedule of Benefits, the collection of cervical cancer screening specimens during an assessment is included and cannot be billed separately unless performed under specific conditions outside a hospital.
Virtual re-assessments are eligible only when conducted via video, not by telephone, and must meet comprehensive virtual care standards.
4What Your Clinical Note Must Show
Ensure the following are documented accurately for billing:
- Full, relevant history and physical exam documentation for the re-assessment.
- Time tracking of service start and end on the patient's permanent medical record.
- Confirmation that the re-assessment is related to a significant change in the patient's clinical status.
- Clarification if this is within the allowed frequency limit or an exception due to hospital admission.
Specific for virtual services:
- Documentation must clearly state that the assessment was conducted via video.
- Ensure compliance with video-specific virtual care service protocols.
5Weak vs. Strong Note Examples
The strong note clearly documents the critical aspects of the re-assessment, including time, detailed examination, and rationale for changes in treatment, while the weak note lacks detail and fails to justify the service adequately.
Patient reviewed, condition stable. Will follow up.
Reviewed patient post-operatively, examining for post-operative bleeding.
Took detailed history and performed physical examination focused on abdominal and pelvic regions.
Documented the assessment duration from 14:00 to 14:30.
Decision made to adjust treatment plan and monitor condition daily.
- Time recorded accurately
- Comprehensive patient evaluation documented
- Clear rationale for treatment decision
