All codes
C097
C097 – Subsequent visit - sixth to thirteenth week inclusive
OHIP Surgical Procedures Code — CARDIAC SURGERY (09) · Schedule of Benefits
A routine assessment in hospital or a non-emergency long-term care facility following the hospital admission assessment, rendered between the sixth and thirteenth week (inclusive) of the patient's stay.
When to Use
- Use for routine cardiac surgery follow-up visits occurring between the 6th and 13th week of a patient's continuous hospital or non-emergency long-term care admission.
- Use when a referring physician attends the patient's surgery without acting as the surgical assistant, as this constitutes a hospital subsequent visit.
- Use when the patient has transitioned from the C092 billing period (first 5 weeks) but has not yet reached the 14th week of stay.
Common Pitfalls
- Billing C097 more than three times in a single week, which will trigger automatic rejections as it exceeds the weekly limit.
- Attempting to claim C097 alongside Special Visit Premiums, which is prohibited for routine rounds.
- Failing to reset the 'admission date' clock when a patient is transferred to a new physician, leading to incorrect code selection between C092, C097, and C099.
Billing Tips
- If an acute intercurrent illness requires more than three visits in a week during this period, bill the additional visits as C121 rather than attempting to force them into the C097 category.
- Always append C101 if the patient is located in the ICU or CCU, as this premium is eligible for addition to the C097 base fee.
Provider Fee$0.00
Specialist Fee$31.00
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CARDIAC SURGERY (09)
Service Type
Hospital In-Patient / Long-Term Care
Code Classes
Assessment
Non-Emergency Long-Term Care In-Patient Services includes Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, and Homes for the Aged.
The weekly limit of 3 visits applies from the start of the 6th week to the end of the 13th week of hospitalization.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.