1What Is the C474 OHIP Code?
What is the C474 Code?
The C474 billing code is designed for use by specialists in the field of Respirology and pertains to medical specific re-assessments conducted on non-emergency hospital in-patients. This service requires a comprehensive re-evaluation of the respiratory condition being managed, involving a full relevant history and a physical examination of one or more systems related to the patient's respiratory status.
Re-assessments may occur when there's a change in bronchodilator, steroid, or ventilation settings, or a pleural drain is reassessed during the same admission. Physicians may overlook billing for these reassessments correctly when misalignment in documentation occurs or when virtual services are not correctly registered under the video consultation requirement.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A473 | Medical specific assessment | Up to once per patient, per in-patient admission | Comprehensive assessment for respiratory disease. |
| C473 | Medical specific assessment | Up to twice within 12 months | Specific assessment during a hospital stay. |
| A471 | Complex medical specific re-assessment | Up to twice within 12 months | Complex re-assessment of respiratory conditions. |
| A474 | Medical specific re-assessment | Up to twice within 12 months | Re-assessment occurring outside of hospital settings. |
3Eligibility Requirements
Eligibility Requirements for C474
- Setting: The C474 code is applicable for non-emergency hospital in-patient services specifically in the respirology category.
- Virtual Care: C474 may only be billed for virtual services delivered via video, not telephone, as per Appendix J, Section 1.
- Frequency: Limited to a maximum of two re-assessments per patient per physician per 12-month period, except in cases of hospital admission which are not subject to these limits.
- Documentation: Start and end times of the service must be recorded in the patient's permanent medical records.
4What Your Clinical Note Must Show
Ensure the following documentation is complete and accurate for each patient encounter.
- Record start and end times of the service.
- Include a full relevant history and physical examination of the respiratory system.
- Document any changes in patient's respiratory care plan, such as bronchodilator, steroid, or ventilation adjustments.
5Weak vs. Strong Note Examples
The strong note succeeds by providing specific details about the patient's condition and changes in management, along with precise timing, which are crucial for compliance and accurate reimbursement. The weak note lacks these details, leaving room for ambiguity and potential billing errors.
Patient reassessed. Changed medication.
Patient underwent full re-assessment due to recent changes in treatment regimen, including increased bronchodilator dosage and new steroid prescription. Physical examination conducted focusing on respiratory status.
Time in: 10:00 AM
Time out: 10:30 AM
- Objective findings: respiratory sounds clear, improved blood O2 levels.
- Updated care plan: Continue with adjusted medications and monitor.
