1What Is the C414 OHIP Code?
Overview of C414
C414 is a billing code under OHIP utilized by gastroenterologists for specific medical re-assessments in non-emergency hospital in-patient settings. It reflects a focused re-evaluation addressing digestive issues within hospitalized patients.
Typically, this service involves reviewing a patient’s condition post-change in treatment, such as adjustments in acid suppression or bowel regimen, or after obtaining endoscopy results. This process ensures the managing physician can tailor ongoing care strategies based on evolving clinical findings.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A413 | Medical specific assessment | Initial | A primary assessment scheduled in the Gastroenterology listing. |
| C413 | Medical specific assessment | Initial | Covers initial assessments in hospital settings. |
| A411 | Complex medical specific re-assessment | Re-assessment | For complex cases requiring detailed evaluation. |
| A414 | Medical specific re-assessment | Follow-up | Re-assessment outside of a hospital in-patient setting. |
3Eligibility Requirements
Eligibility Criteria
- Applicable Settings: C414 is available for non-emergency hospital in-patient services within the gastroenterology specialty.
- Diagnosis Requirements: Submissions must include one of the following diagnostic codes: 263, 555, 556, 571, or 579.
- Limitations: Each gastroenterologist may bill C414 up to two times per patient within a consecutive 12-month period unless specifically for a hospital admission.
- Documentation: The start and end times of the service must be documented distinctly in the patient's record.
- Virtual Care Options: C414 can be billed for virtual re-assessments only when performed via video (billed as C414A). Telephone consultations are not eligible.
4What Your Clinical Note Must Show
Physicians must ensure comprehensive documentation of the service rendered.
- Record the start and end times of the assessment in the patient’s permanent medical record.
- Include a relevant history and physical examination of the digestive system.
- Ensure all details correlate with the specified diagnostic codes.
5Weak vs. Strong Note Examples
The strong note provides a detailed history, aligns findings with a specific diagnostic code, and logs the exact time, thus ensuring clarity and compliance.
Patient seen, reassessed digestive issues. Adjusted medication.
Reviewed patient history following initial treatment modification. Conducted a detailed gastroenterological examination focusing on symptoms that correlate with diagnostic code 556. Adjusted proton pump inhibitor regimen based on reported symptoms and endoscopy outcomes.
- Time of service: 10:00 AM - 10:20 AM
- Diagnostic code: 556
