All codes
C059
C059 – Subsequent visit after thirteenth week
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A routine assessment in hospital following the hospital admission assessment, rendered to a patient who has been hospitalized for more than thirteen weeks.
When to Use
- Use C059 for routine daily or periodic follow-up assessments once the patient has surpassed the 91-day (13-week) threshold of continuous hospitalization.
- Apply this code for long-term care patients or those in chronic care beds who have transitioned past the eligibility windows for C052 and C057.
Common Pitfalls
- Billing C059 before the 13-week mark is a common audit trigger; ensure the patient's admission date is calculated correctly to avoid rejection or clawbacks.
- Exceeding the 6-visit-per-month limit without billing C121 for an acute intercurrent illness will result in automatic rejection of the 7th visit.
- Attempting to bill C059 for virtual or telephone follow-ups will result in rejection, as this code strictly requires in-person attendance.
Billing Tips
- Track the patient's admission date in your billing software to automatically trigger the switch from C057 to C059 on the 92nd day of admission.
- If a patient experiences an acute change in status requiring more than 6 visits in a month, bill the additional visits as C121 to bypass the C059 monthly limit.
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
Service must be a routine assessment following the admission assessment.
If billed as 'Attendance at Surgery', the physician must be present at the request of the patient/representative but not assisting.
C059 is not eligible for virtual care (video or telephone).
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