C168 – Subsequent visits
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Concurrent care is any routine assessment rendered in hospital by the consultant following the consultant's first major assessment of the patient when the family physician remains the most responsible physician but the latter requests continued directive care by the consultant. As an assessment, this service includes the specific elements of assessments outlined in of the Schedule of Benefits. Payment Rules Claims for concurrent care are limited to 4 per week during the first week of concurrent care, and 2 claims per week thereafter. Services in excess of this limit are not eligible for payment.
When to Use
- Use C168 when you have completed an initial consultation (A-prefix) and the patient remains under the care of a family physician who requests your ongoing directive input for a specific condition.
- Use C168 for routine follow-up assessments in a hospital setting where you are not the Most Responsible Physician (MRP) but are providing active, directive management.
Common Pitfalls
- Billing C168 when you have assumed the role of MRP; in this case, you must switch to subsequent hospital care codes (C002/C003) as C168 is strictly for concurrent care.
- Exceeding the weekly frequency limits (4 in the first week, 2 thereafter) will result in automatic rejection; ensure your billing software tracks these limits per patient per physician.
- Attempting to attach Special Visit Premiums to C168; C-prefix codes are ineligible for these premiums, unlike A-prefix assessments.
Billing Tips
- If you are seeing a patient in the ICU/CCU, you can add the C101 premium to the C168 claim to increase the total reimbursement for the visit.
- Ensure your documentation clearly reflects a request for directive care from the MRP to justify the use of C168 over standard supportive care codes.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
Concurrent care is defined as a routine assessment rendered in hospital by a consultant following the consultant's first major assessment of the patient when the family physician remains the most responsible physician but the latter requests continued directive care by the consultant.
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