C042 – Subsequent visit - first five weeks
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A routine subsequent visit for an in-patient of an acute care hospital, rendered by a neurosurgeon. This service is for visits occurring within the first five weeks following the hospital admission assessment. A subsequent visit is any routine assessment in hospital following the hospital admission assessment. See for general rules on subsequent visits.
When to Use
- Use C042 for routine daily neurosurgical rounds on an admitted patient within the first 35 days following the initial hospital admission assessment.
- Use C042 when providing standard post-operative management for a neurosurgical patient who remains in an acute care bed during the five-week window post-admission.
Common Pitfalls
- Billing C042 alongside special visit premiums (e.g., A900 series) will result in automatic rejection, as neurosurgery is not an eligible specialty for these premiums.
- Attempting to claim C042 beyond the five-week threshold from the original admission date; you must switch to C047 or C049 for subsequent visits after day 35.
- Claiming C042 on the same day as C122, C123, or C124 when acting as the Most Responsible Physician (MRP) will trigger a billing conflict.
Billing Tips
- Always append the E083 premium when you are the MRP to receive the 30% fee increase, provided you meet the hospital remuneration eligibility criteria.
- If the patient is in an ICU or CCU setting, ensure you add the C101 premium to the C042 claim to capture the additional intensity of care.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
NON-EMERGENCY HOSPITAL IN-PATIENT SERVICES. See to . For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable - see to .
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