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C157
C157 – Subsequent visit - sixth to thirteenth week inclusive
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Subsequent visit for a hospital in-patient rendered by an Endocrinology & Metabolism specialist during the sixth to thirteenth week of hospitalization inclusive.
When to Use
- Use C157 for routine endocrine management of an inpatient once the patient has reached their 6th week of continuous hospitalization.
- Transition to C157 from C152 immediately upon the patient entering their 6th week of stay to ensure accurate fee capture.
- Use C157 for ongoing metabolic monitoring of long-term inpatients up to the end of the 13th week, after which you must switch to C159.
Common Pitfalls
- Billing C157 beyond the 13th week of hospitalization, which will result in rejection or audit recovery; use C159 for visits thereafter.
- Attempting to bill more than three C157 visits in a rolling seven-day period, which triggers automatic claim rejection.
- Failing to account for the 'admission date' reset when a patient is transferred to your service, leading to incorrect code selection between C152, C157, and C159.
Billing Tips
- If an acute intercurrent illness requires a 4th visit within a week, bill C121 instead of C157 to bypass the weekly frequency limit.
- Ensure the E084 premium is appended to C157 when providing weekend or holiday care to maximize reimbursement as an Endocrinology MRP.
Provider Fee$0.00
Specialist Fee$34.10
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Hospital In-Patient
Code Classes
Assessment
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