C028 – Additional subsequent visits - nursing home or home for the aged
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Concurrent care is any routine assessment rendered in hospital by the consultant following the consultant’s first major assessment of the patient when the family physician remains the most responsible physician but the latter requests continued directive care by the consultant.
When to Use
- Use C028 when you are providing ongoing directive care for a stable patient in a hospital setting where the family physician remains the Most Responsible Physician (MRP).
- Use C028 for routine follow-up assessments when the patient's condition does not meet the criteria for an acute intercurrent illness visit (C121).
Common Pitfalls
- Billing C028 for patients who are not currently admitted as in-patients in a hospital, as this code is strictly for hospital concurrent care.
- Exceeding the frequency limits of 4 visits in the first week and 2 visits per week thereafter, which will trigger automatic rejections.
- Confusing C028 with C121; C121 should be used for acute changes in status, whereas C028 is strictly for routine concurrent care.
Billing Tips
- Ensure the patient's chart clearly reflects the request from the MRP for your continued directive care to satisfy the documentation requirement for concurrent care.
- Always use the 'C' prefix for hospital-based concurrent care to distinguish it from the 'W' prefix used for nursing home visits.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Institutional Visit
Consultation/Visit
The family physician must remain the most responsible physician but the latter requests continued directive care by the consultant.
Maximum 3 per patient per month in nursing home settings
Concurrent care is limited to 4 per week in the first week and 2 per week thereafter
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