1What Is the C411 OHIP Code?
C411 is an OHIP billing code for complex medical specific re-assessments, particularly relevant in gastroenterology for hospital in-patients. Such assessments are critical for conditions like variceal bleeding or decompensated liver disease during an admission.
These assessments involve reconsidering the patient's medical history, current illness status, and treatment progress, focusing on the seriousness and complexity of the condition. C411 captures instances where a deeper and more nuanced review is essential.
Frequently missed due its specificity, C411 requires a detailed approach to patient reassessment, making documentation and understanding of the eligibility criteria crucial.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A413 | Medical specific assessment | N/A | Used for standard assessments in gastroenterology. |
| C413 | Medical specific assessment | N/A | Used for specific assessments within the hospital. |
| A411 | Complex medical specific re-assessment | N/A | Similar to C411 but rendered outside hospital settings. |
| A414 | Medical specific re-assessment | N/A | Standard re-assessment, less intensive than C411. |
3Eligibility Requirements
To bill for C411, a gastroenterologist must conduct the assessment on a non-emergency hospital in-patient. This reassessment is due to the complexity or seriousness of the underlying condition. Eligible diagnostic codes include 263, 555, 556, 571, and 579.
The procedure can also be rendered virtually as C411A with video-only consultations being eligible. Note that such reassessments are limited to four occurrences per patient per physician annually. Accurate recording of the start and end times is mandatory to receive payment.
4What Your Clinical Note Must Show
Mandatory recording on the patient's permanent medical record.
- Record start and end time of the assessment.
Ensure selected diagnostic codes align with complexity requirements.
- Use eligible codes: 263, 555, 556, 571, 579.
For virtual consultation, use C411A code.
- Must be video-based, telephone is not eligible.
5Weak vs. Strong Note Examples
The strong note succeeds because it includes comprehensive details about the clinical findings, the reassessment process, and planned interventions, providing a clear rationale for the code's use.
Reviewed patient's condition and prescribed medication.
Completed a detailed reassessment of patient presenting with acute variceal bleeding.
Reviewed changes in liver function tests and adjusted treatment plan accordingly.
Considered potential complications, planned follow-up interventions.
- Observed significant portal hypertension development.
