1What Is the C313 OHIP Code?
What is C313?
C313 is a billing code used under the Ontario Health Insurance Plan (OHIP) by specialists in Physical Medicine and Rehabilitation, specifically physiatrists, for performing a medical specific assessment on hospital in-patients. This assessment involves a detailed evaluation of new or existing conditions such as contractures, new weaknesses, or the need for splinting post-surgery.
The typical context for a C313 assessment is when a physiatrist is called to assess a specific issue on the hospital ward rather than providing a comprehensive rehabilitation plan. These assessments are crucial for precise diagnosis and management of specific medical concerns.
Physicians may often miss billing this code due to misunderstandings about its specific applicability, restrictions on frequency, and the requirement for documented time tracking during the assessment.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A313 | Medical specific assessment | As a non-hospital service | Identical service as C313 performed in a community setting. |
| W314 | General re-assessment of patient in nursing home | As needed per clinical requirement | A general re-assessment in a nursing home setting. |
| A310 | Medical specific re-assessment | Unlimited as needed | Re-assessment of the specific medical issue initially addressed. |
| A311 | Complex medical specific re-assessment | Unlimited as needed | Involved re-assessment for complex cases requiring detailed evaluation. |
3Eligibility Requirements
Eligibility
- Setting: Must be performed in a non-emergency hospital in-patient setting.
- Frequency: Limited to one assessment per patient per physician per 12-month period. Exceptions include presentations with a distinctly unrelated diagnosis or a subsequent hospital admission assessment after 90 days.
- Virtual Care: C313 can be rendered virtually and billed as C313A but must be conducted via video, not by telephone.
- Documentation: Physicians must maintain accurate, time-stamped records of the start and end times of the assessment in the patient's permanent medical record.
4What Your Clinical Note Must Show
C313 assessment requires precise recording of service duration.
- Start time of the assessment must be noted.
- End time of the assessment must be documented.
- These details should be included in the patient's permanent medical record.
5Weak vs. Strong Note Examples
The strong note excels as it includes a thorough clinical description, explicit recommendations, and adheres to time-recording requirements, unlike the weak note.
Performed assessment on patient's new weakness. Recommended splinting.
Completed a detailed assessment for a new weakness in the patient's right arm. History explored prior function and recent onset. Conducted a thorough examination of the upper extremity revealing decreased muscle strength.
Recommended a specific splinting protocol and provided rationale based on the observed functional impairment.
- Assessment start: 10:00 AM
- Assessment end: 10:45 AM
