C048 – Subsequent visit
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 C048 when you have completed an initial consultation and the MRP requests your ongoing directive input for a neurosurgical condition while they remain the primary physician.
- Use C048 for routine follow-up assessments in a hospital setting when the patient does not meet the criteria for a formal subsequent visit under C042, C047, or C049.
Common Pitfalls
- Billing C048 for patients in palliative care beds will result in an automatic rejection as these are explicitly excluded.
- Attempting to claim special visit premiums (e.g., GP65-GP78) in conjunction with C048 will lead to claim rejection, as C048 is restricted from these premiums.
- Exceeding the frequency limit of 4 per week in the first week or 2 per week thereafter will trigger a rejection for exceeding the maximum allowable service count.
Billing Tips
- Ensure the request for concurrent care from the MRP is clearly documented in the patient's chart to justify the necessity of your ongoing involvement.
- Do not bill C048 for virtual encounters, as this code is not included in Appendix J and is ineligible for telephone or video reimbursement.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Institutional Visit
Consultation/Visit
For Hospital In-Patient (Concurrent Care): The service must be a routine assessment rendered by the consultant following the consultant’s first major assessment of the patient when the family physician remains the most responsible physician (MRP) but the latter requests continued directive care by the consultant.
Non-Emergency Long-Term Care In-Patient Services includes Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, and Homes for the Aged.
C048 is not eligible for virtual care (video or telephone) as it is not listed in Appendix J (-).
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