C099 – Subsequent visits - after thirteenth week
OHIP Surgical Procedures Code — CARDIAC SURGERY (09) · Schedule of Benefits
A subsequent visit is any routine assessment in hospital following the hospital admission assessment, as defined on . This service is rendered by a specialist in Cardiac Surgery (09) to an admitted patient more than 13 weeks after the admission date. As a type of assessment, it includes the specific elements outlined on , such as a direct physical encounter, history taking, and providing advice to the patient. Visits are limited to a maximum of six per month, as per the rules on .
When to Use
- Use C099 for routine hospital follow-up visits by a Cardiac Surgeon occurring more than 13 weeks after the patient's original hospital admission date.
- Use C099 when a patient is transferred to your service from another physician, provided the date of your first assessment is more than 13 weeks after the patient's initial hospital admission.
Common Pitfalls
- Billing C099 before the 13-week threshold has passed, which will result in a rejection or audit recovery for using the incorrect subsequent visit code.
- Exceeding the maximum of six subsequent visits per month, which triggers automatic claim rejection under the Schedule of Benefits rules.
- Attempting to bill E083 or E084 concurrently with C121, which is explicitly prohibited by the billing rules.
Billing Tips
- If you are the Most Responsible Physician (MRP), ensure you append E083 for weekday visits or E084 for weekend/holiday visits to maximize the fee, provided you meet the hospital remuneration criteria.
- If the patient is located in an ICU or CCU, remember to add C101 to your C099 claim to capture the appropriate unit premium.
Effective: June 1, 2025
A. Consultations and Visits
CARDIAC SURGERY (09)
Assessment
Hospital and Institutional Consultations and Assessments
Attendance at surgery by the referring physician, if requested by the patient but without assisting, constitutes a hospital subsequent visit.
When the complexity of the medical condition requires the services of several physicians in different disciplines, each physician visit constitutes a subsequent visit, subject to the per-physician limits.
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