C079 – Geriatric subsequent visit - after thirteenth week
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
C079 is a subsequent visit for a non-emergency hospital in-patient, applicable for care provided by a Geriatrics (07) specialist after the thirteenth week of hospitalization. As defined in , a subsequent visit is any routine assessment in a hospital following the hospital admission assessment. It includes all common elements of insured services (e.g., record keeping, conferring with colleagues) and the specific elements of assessments (e.g., direct physical encounter with the patient, history taking, physical examination, providing advice) as detailed in -. This service is for routine care; for acute intercurrent illnesses, C121 may be claimed in excess of the monthly limit as per .
When to Use
- Use C079 for routine, ongoing geriatric management of a stable inpatient once the patient has exceeded the thirteen-week threshold of their current hospital admission.
- Use this code for scheduled follow-up assessments where no acute intercurrent illness is present, distinguishing it from C121 which is reserved for acute changes in status.
Common Pitfalls
- Billing C079 in conjunction with special visit premiums (e.g., K963) will result in automatic rejection, as these are restricted for all 'C' prefix hospital visits.
- Exceeding the 6-visit-per-month limit for C079 will trigger rejections; ensure any additional visits required for acute episodes are billed under C121 with appropriate diagnostic codes.
- Attempting to bill C079 for patients in palliative care designated beds may lead to audit flags if the documentation does not clearly support routine geriatric management versus palliative care management.
Billing Tips
- If you are the Most Responsible Physician (MRP), always append E083 (or E084 on weekends/holidays) to your C079 claim to capture the 30% or 45% premium, provided you meet the specific specialty and remuneration criteria.
- If the patient is admitted to an ICU or CCU, ensure you add the C101 premium to your C079 claim to maximize the value of the routine visit.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
All insured services must be documented in the medical record, establishing that the service was provided, is the service submitted, and was medically necessary.
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