C162 – Nephrology subsequent visit - first five weeks
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
C162 is a subsequent visit rendered by a Nephrologist to an acute care hospital in-patient during the first five weeks after admission. A subsequent visit is defined as any routine assessment in hospital following the hospital admission assessment (). The service includes the specific elements of an assessment as outlined in , such as a direct physical encounter with the patient, taking a patient history, performing a physical examination, and providing advice and information to the patient or their representative. When a hospital in-patient is transferred from one physician to another, subsequent visits by the second physician are calculated based on the actual admission date of the patient ().
When to Use
- Use C162 for routine nephrology follow-up visits during the first 35 days of an inpatient admission when you are not the Most Responsible Physician (MRP).
- Use C162 when providing a subsequent visit to a patient who has been transferred to your service from another physician, provided the visit occurs within the 35-day window from the original hospital admission date.
- Use C162 when attending a patient in the hospital at the request of the patient or their representative, even if you are not performing a procedure during that visit.
Common Pitfalls
- Billing C162 on the day of discharge is a rejection risk; you must use C124 instead if you are the MRP, or ensure the visit is distinct if you are a consultant.
- Attempting to bill C162 for visits occurring after the 35-day threshold; these must be billed using the appropriate long-stay subsequent visit code (C167).
- Billing C162 on the same day as a consultation (A160) for the same patient, which will trigger a rejection as the visit is considered part of the consultation service.
Billing Tips
- Always verify the patient's original hospital admission date rather than your own start date, as the 35-day count for C162 is strictly tied to the admission date.
- If the patient is located in an Intensive Care Unit, remember to append the C101 premium to your C162 claim to capture the additional complexity of the ICU environment.
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