1What Is the C473 OHIP Code?
C473 is an OHIP billing code used by respirologists to conduct medical specific assessments on hospital in-patients. This assessment involves a thorough history and detailed examination to diagnose or manage respiratory conditions such as pleural effusions, pulmonary nodules, or unexplained hypoxaemia. The objective is to provide comprehensive care and expert evaluations.
A medical specific assessment in a respiratory context may be missed if a full history and examination are not documented or if the conditions for repeat assessment within the 12-month period are unclear. It's crucial for specialists to ensure precise documentation to meet the billing criteria.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A473 | Medical specific assessment | Same conditions as C473 | Out-patient equivalent of C473 for respiratory disease assessments. |
| A471 | Complex medical specific re-assessment | Restrictions based on service complexity and diagnosis. | Re-assessment in respiratory cases requiring more complex evaluations. |
| A474 | Medical specific re-assessment | Available for follow-up after an initial assessment. | Follow-up assessments in respiratory disease management. |
| C471 | Complex medical specific re-assessment | Up to two re-assessments per year, subject to complexity and diagnosis. | Complex re-assessment in in-patient respiratory cases. |
3Eligibility Requirements
Eligibility for billing C473 involves the following criteria:
- Service Setting: Must be conducted as a non-emergency hospital in-patient service.
- Frequency Limitation: Limited to one specific assessment per patient per physician per 12-month period unless the patient requires a second assessment due to a different diagnosis or a hospital admission after 90 days.
- Virtual Care: Eligible for virtual care delivery via video, but telephone consultation is not covered under this service code.
- Documentation: The start and end time of the service must be recorded in the patient's permanent medical record.
Refer to General Preamble GP23 and GP48 for detailed documentation requirements.
4What Your Clinical Note Must Show
Ensure the following documentation is present:
- Full history of the presenting complaint
- Detailed examination findings of affected parts or systems
- Diagnosis and management plan
- Start and end times of the assessment service
5Weak vs. Strong Note Examples
The strong note details the clinical findings and plan, providing timeframes, whereas the weak note lacks specific details and timing.
Patient seen for evaluation. History and exam conducted. Assessment completed.
Patient presented with dyspnea and suspected pleural effusion. A comprehensive history was taken, including previous respiratory episodes and recent symptom development.
Physical examination indicated reduced breath sounds over the left lower lung field. Diagnosis of pleural effusion was made.
Plan includes further imaging and potential thoracentesis.
- Start Time: 10:00 AM
- End Time: 10:30 AM
