1What Is the C263 OHIP Code?
C263 is an OHIP billing code used primarily by pediatricians for performing a medical specific assessment of in-patient children. This assessment typically focuses on defined problems a child faces during their hospital stay, allowing the physician to evaluate and manage the patient's condition effectively.
The use of C263 is integral where the physician attends a delivery, especially if the newborn is sick. The billing of C263 enables physicians to provide the required medical attention to newborns who need immediate and thorough medical assessment right after birth.
This code can often go unbilled due to oversight or misunderstanding of its applicability during in-patient situations or when a newborn requires an immediate assessment after delivery. Understanding the proper use of C263 is crucial in ensuring pediatric patients receive comprehensive care.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A263 | Medical specific assessment | Governs by specialty listing and General Preamble assessment rules | Used for medical specific assessments outside in-patient settings. |
| A264 | Medical specific re-assessment | Governs by specialty listing and General Preamble assessment rules | For re-assessments in pediatric out-patient settings. |
| A661 | Complex medical specific re-assessment | Governs by specialty listing and General Preamble assessment rules | For complex re-assessments requiring extensive review. |
| C264 | Medical specific re-assessment | Governs by specialty listing and General Preamble assessment rules | For re-assessments in pediatric in-patient settings. |
3Eligibility Requirements
To bill C263, the service must be rendered to an in-patient setting in a hospital. C263 can be performed virtually but only through video calls, not telephone. This service is detailed under Virtual Delivery, Appendix J, Section 1, making it eligible as a Video-Only Comprehensive Virtual Care Service. Physicians must also observe the pediatric listings and the General Preamble assessment rules to ensure proper billing frequency. The out-patient equivalent of this service is billed as A263.
4What Your Clinical Note Must Show
Ensure the patient is documented as an in-patient during the time of assessment.
- Admission records
- Patient hospital status documentation
Detailed justification of the medical assessment performed, including specific conditions addressed.
- Assessment report
- Conditions or problems assessed
If assessment is performed virtually, ensure it is by video only.
- Video consultation records
- Confirmation of comprehensive virtual care service
5Weak vs. Strong Note Examples
The strong note is successful because it provides a detailed account of the assessment, including specific actions taken and documentation confirming the service was delivered per OHIP guidelines. The weak note lacks specificity and essential documentation details.
Patient assessed in-patient for fever. Follow-up next day if needed.
Detailed in-patient assessment conducted. Focused on addressing a high fever related to an underlying infection.
Complete physical examination conducted, vital signs monitored, and blood tests ordered for further analysis.
- Documented patient admission status
- Video consultation confirmation (if virtual)
- Comprehensive assessment details
