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C038
C038 – Subsequent visits per month
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A routine assessment rendered in hospital by a consultant surgeon 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 C038 when you are the consultant surgeon providing ongoing directive care for a specific surgical issue while the patient remains under the primary care of a hospitalist or family physician.
- Use C038 for routine daily or periodic rounds on a patient you have already performed a C035 consultation on, provided you are not the Most Responsible Physician (MRP).
Common Pitfalls
- Billing C038 when you have assumed the role of MRP; if you are the MRP, you must use the C032/C033 series instead.
- Exceeding the weekly limit of 2 visits after the first week of concurrent care, which will trigger an automatic rejection.
- Attempting to bill C038 on the same day as a C035 consultation or a C033 specific assessment, which is strictly prohibited.
Billing Tips
- If the patient develops an acute, unrelated surgical complication requiring more frequent visits than the C038 limit allows, switch to C121 to justify the additional volume.
- Ensure your chart notes clearly document the request from the MRP for your continued directive care to satisfy audit requirements for concurrent care status.
Provider Fee$0.00
Specialist Fee$34.10
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Hospital In-Patient
Code Classes
Assessment
Must follow a major assessment (Consultation or Specific Assessment) by the same surgeon.
The surgeon must be providing 'directive care' at the request of the MRP.
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