C117 – Subsequent visit - sixth to thirteenth week inclusive
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A routine assessment in hospital following the hospital admission assessment, rendered to a hospital in-patient between the sixth and thirteenth week of their stay (inclusive).
When to Use
- Use C117 for routine daily or periodic assessments of an inpatient who has reached their 6th week of continuous hospitalization but has not yet exceeded 13 weeks.
- Use C117 when providing routine follow-up care for a patient transferred from another facility, ensuring the billing date is calculated from the original admission date to the hospital system.
Common Pitfalls
- Billing C117 beyond the 13th week of admission, which will trigger a rejection; switch to C119 once the 14th week begins.
- Exceeding the maximum of 3 visits per week for routine care, as the Ministry strictly enforces this limit for C117.
- Attempting to bill C117 for an acute intercurrent illness; use C121 instead to bypass the weekly limit and ensure proper payment.
Billing Tips
- Track the patient's admission date precisely in your billing software to automate the transition from C112 to C117 at week 6, and C117 to C119 at week 14.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Subsequent Visit
Assessment
Must be a routine assessment following the admission assessment.
If a patient is referred, the second physician's 'admission date' for fee calculation starts on the date of their first assessment.
Special visit premiums are not eligible for patients seen during rounds.
Attendance at surgery by a referring physician (not assisting) is billed as a subsequent visit.
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