C087 – Subsequent visit
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A routine assessment in hospital or a long-term care facility following the hospital admission assessment, rendered between the sixth and thirteenth week of the patient's stay.
When to Use
- Use C087 for routine inpatient assessments occurring specifically between the start of the 6th week and the end of the 13th week of the patient's hospital stay.
- Use C087 when the patient has been transferred to your care, using the original hospital admission date to determine if the patient falls within the 6-13 week eligibility window.
- Use C087 for routine follow-ups when the patient is not in a designated palliative care bed, as palliative care codes like C982 must be used instead.
Common Pitfalls
- Billing C087 after the 13th week of admission, which will result in rejections; switch to C089 for visits beyond this timeframe.
- Billing C087 for an acute intercurrent illness that exceeds the 3-visit-per-week limit; use C121 for these additional medically necessary assessments.
- Confusing the admission date for a referred patient with the hospital's original admission date; for referrals, the date of your first assessment serves as the 'admission date' for the 6-13 week calculation.
Billing Tips
- Ensure your billing software tracks the patient's admission date accurately to trigger the transition from C082 to C087 at the 6-week mark.
- If you are called to see a patient on an emergency basis, do not use C087; bill the appropriate A-prefix code combined with the applicable Special Visit Premium (GP65-GP78).
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Subsequent Visit
Assessment
The service must be a routine assessment following the admission assessment.
If a patient is referred from one physician to another, the date the second physician assesses the patient for the first time is considered the 'admission date' for determining the 6-13 week window.
If a patient is transferred (not referred), the 6-13 week window is calculated based on the actual original admission date.
For emergency calls and other special visits to in-patients, use General Listings (A-prefix) and Special Visit Premiums ( to ) instead of C087.
If a physician assesses another physician's patient on an emergency basis, General Listings (A-prefix) apply.
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