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C126

C126Subsequent visit - day of discharge, medically complex patient

OHIP Surgical Procedures Code · Schedule of Benefits

A subsequent visit rendered by the Most Responsible Physician (MRP) on the day of discharge for a medically complex patient who has been hospitalized for at least 7 days and has multiple contributing diagnoses.

When to Use

  • Use C126 for medically complex patients hospitalized for at least 7 days who require a minimum of 45 minutes of direct physician time to coordinate discharge, reconcile complex medication regimens, and finalize the discharge summary.
  • Choose C126 over C124 when the complexity of the discharge process necessitates extensive documentation and multi-disciplinary coordination that exceeds the scope of a standard discharge visit.

Common Pitfalls

  • Billing C126 without documenting the 45-minute time requirement, which triggers an automatic adjustment to the lower-paying C124 during audit or claims processing.
  • Attempting to bill C122 or C123 on the same day as C126, which will result in an automatic rejection of the subsequent visit codes.
  • Failing to complete the discharge summary within the mandatory 48-hour window, rendering the C126 claim non-compliant with the Schedule of Benefits.

Billing Tips

  • Always append the E083 premium to C126 to maximize the claim value, provided you meet the criteria for MRP subsequent visit premiums.
  • Ensure the discharge summary explicitly lists the reason for admission, procedures, diagnosis, and discharge medications to satisfy the specific documentation requirements of C126.

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