All codes
C069
C069 – Subsequent visit after thirteenth week (maximum 6 per patient per month)
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A routine assessment rendered to a hospital in-patient by an Orthopaedic Surgeon starting from the 14th week of the patient's stay.
When to Use
- Use C069 for routine orthopaedic follow-up assessments for patients who have exceeded 91 days of continuous hospitalization.
- Use this code when the patient remains an orthopaedic in-patient beyond the 13-week limit applicable to C067.
Common Pitfalls
- Billing C069 before the 92nd day of hospitalization will result in an automatic rejection or audit flag for incorrect code selection.
- Exceeding the maximum of 6 claims per patient per month will cause the Ministry to reject the excess services, as this code is strictly capped compared to earlier visit codes.
- Failing to account for the continuous clock when a patient is transferred between services; the 13-week threshold is based on the total length of stay, not the duration under the current surgeon.
Billing Tips
- If the patient develops a new, acute orthopaedic or non-orthopaedic issue requiring additional visits beyond the monthly limit of 6, bill C121 for the intercurrent illness rather than attempting to force additional C069 claims.
- Ensure the E083 premium is appended to C069 if you are the MRP and meet the remuneration criteria, as this provides a 30% increase to the base fee.
Provider Fee$0.00
Specialist Fee$31.00
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Hospital In-Patient Service
Code Classes
Assessment
Patient must be an in-patient in an acute care hospital
Service must be rendered after the 13th week of the patient's stay (or 13th week of specialist care if referred)
Not eligible for virtual care (Appendix J)
For Chronic Care or Nursing Home settings, use W-prefix codes instead
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