C002 – Subsequent visit - first five weeks
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit is any routine assessment rendered in a hospital following the hospital admission assessment. `C002` specifically applies to visits rendered within the first five weeks of admission. It includes all common elements of an insured service (, ) and all specific elements of an assessment (). This service can also be claimed for attendance at surgery when requested by the patient or their representative, provided the physician does not assist, and for visits by different specialists in cases of multidisciplinary care where each visit constitutes a subsequent visit.
When to Use
- Use C002 for routine daily hospital visits occurring within the first 35 days of the patient's original admission date.
- Use C002 when attending surgery at the patient's request to provide a medical opinion, provided you are not acting as the surgical assistant.
- Use C002 for multidisciplinary care visits where you are a consulting specialist providing a subsequent assessment, even if the MRP has already billed for the day.
Common Pitfalls
- Billing C002 beyond the 35-day window from the original admission date, which requires transitioning to C007 or C009.
- Attempting to claim special visit premiums (e.g., A900 series) alongside C002, which will result in automatic rejection as C-prefix codes are ineligible for these premiums.
- Failing to recognize that the 35-day count is based on the patient's original hospital admission date, not the date the patient was transferred to your care.
Billing Tips
- Always append the E083 (30%) or E084 (45%) premium if you are the Most Responsible Physician (MRP) and meet the remuneration criteria to maximize the value of the C002 visit.
- If you are managing an intercurrent illness in a stable patient, ensure you distinguish between a standard C002 visit and a C121 additional visit, as E083/E084 premiums cannot be applied to C121.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
All insured services must be documented in the patient's medical record to establish that the service was provided, medically necessary, and is the service for which the account is submitted ().
As an assessment, this service must include documentation of a direct physical encounter, history taking, and other inquiries necessary to form an opinion on the patient's condition ().
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