C109 – First person seen
OHIP Surgical Procedures Code — GENERAL PREAMBLE · Schedule of Benefits
The C109 is a 'first person seen' special visit premium for non-elective diagnostic services rendered in a hospital. It is payable to specialists in Diagnostic Radiology, Radiation Oncology, or Nuclear Medicine for a visit to an acute care hospital in-patient, out-patient, or emergency department patient. The special visit must be for the purpose of interpreting the results of a diagnostic service, performing a procedure, rendering a diagnostic radiology or nuclear medicine consultation, or to conclude that a procedure is not medically indicated. This premium applies to services rendered during evenings (17:00-24:00) from Monday to Friday. It is payable in addition to the fee for the primary diagnostic service, or by itself if the decision is made not to perform the procedure. A key condition for payment is that the request for the service must relate to a patient's condition requiring urgent interpretation that affects the patient's management.
When to Use
- Use C109 when you are physically called into the hospital to interpret an urgent diagnostic study between 17:00 and 24:00 on a weekday.
- Use C109 when you attend the hospital to assess a patient for a procedure but determine the procedure is not medically indicated, provided the request was urgent.
Common Pitfalls
- Billing C109 for remote interpretations performed via PACS or teleradiology is a common audit trigger, as this code strictly requires physical attendance at the hospital.
- Attempting to bill C109 in addition to another special visit premium (such as C110) for the same patient encounter will result in an automatic rejection.
- Failing to document the exact time of the visit in the medical record is a frequent cause for recovery during Ministry audits.
Billing Tips
- Ensure the request for the service is clearly documented as urgent and related to immediate patient management to satisfy the 'non-elective' requirement.
- If multiple patients are seen during the same hospital trip, bill C109 for the first patient and the appropriate 'additional person' premium for subsequent patients.
Effective: April 1, 2025
GP. General Preamble
GENERAL PREAMBLE
Premium
Other Premiums (including After Hours Procedure Premiums)
The time at which the special visit takes place must be documented on the medical record.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.