C009 – Subsequent visit - after thirteenth week
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A routine assessment rendered to a hospital in-patient after the thirteenth week of hospitalization.
When to Use
- Use C009 for routine daily management of a patient who has been hospitalized for more than 91 days, transitioning from C007.
- Use C009 when providing ongoing care for long-term alternate level of care (ALC) patients who remain in an acute bed beyond the 13-week threshold.
Common Pitfalls
- Billing C009 before the 92nd day of hospitalization will result in a rejection or audit recovery; ensure the admission date is calculated correctly from the initial hospital entry.
- Failing to reset the clock to C002 upon accepting a patient transfer from another physician is a common error that leads to overbilling C009.
- Exceeding the limit of 6 visits per month will trigger automatic rejections, as C009 is strictly capped compared to the higher frequency allowed for C002.
Billing Tips
- Ensure you append the appropriate Hospitalist premium code if you meet the eligibility criteria, as C009 is a qualifying service for the 17% increase.
- If a patient develops an acute, unrelated condition requiring extra attention, bill C121 instead of C009 to avoid the 6-visit-per-month cap.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Hospital In-patient Service
Assessment
Must be a routine assessment following the hospital admission assessment.
Requires a direct physical encounter with the patient including history and physical examination.
The physician must be in the hospital to assess their own patient or a patient transferred to their care.
Subsequent visits are calculated based on the actual admission date of the patient, even if transferred between physicians.
Attendance at surgery by a referring physician (who does not assist) constitutes a hospital subsequent visit.
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