C167 – Nephrology 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 by a Nephrologist to an in-patient of an acute care hospital. This service is applicable from the sixth to the thirteenth week of admission, inclusive. This service is limited to a maximum of three visits per patient per week. Services in excess of the limit are not eligible for payment. According to , if the complexity of the medical condition requires the services of several physicians in different disciplines, each physician visit constitutes a subsequent visit.
When to Use
- Use C167 for routine nephrology follow-up visits occurring between the 6th and 13th week of an acute care hospital admission.
- Use C167 when managing stable chronic kidney disease or dialysis patients who have exceeded the 5-week limit for C162 but have not yet reached the 14-week threshold for C169.
Common Pitfalls
- Billing more than three C167 visits in a single week will result in automatic rejection of the excess claims.
- Failing to switch to C121 when an intercurrent illness occurs leads to lost revenue, as C121 bypasses the weekly frequency limits of C167.
- Miscalculating the admission date when taking over care from another physician; remember that the patient's original admission date dictates the code, not the date you assumed care.
Billing Tips
- Always append E083 if you are the Most Responsible Physician (MRP) to receive the 30% premium on top of the C167 fee.
- If you see the patient on a weekend or holiday, use E084 instead of E083 to capture the 45% MRP premium.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
The 'C' prefix indicates services rendered to non-emergency in-patients in an acute care hospital.
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