C169 – Nephrology subsequent visit - after thirteenth week
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit by a Nephrologist to a hospital in-patient, rendered after the thirteenth week of admission. According to , a subsequent visit is any routine assessment in hospital following the hospital admission assessment. It includes all the specific elements of an assessment as outlined in .
When to Use
- Use C169 for routine nephrology follow-up visits for an inpatient who has been hospitalized for more than 13 weeks.
- Use C169 when providing ongoing nephrology management for a patient transferred to your service, provided the patient's total hospital stay exceeds 13 weeks from the original admission date.
Common Pitfalls
- Billing C169 based on the date the patient was transferred to your care rather than the patient's actual hospital admission date, which can lead to incorrect fee code selection.
- Failing to account for the 13-week threshold; using C169 before the 92nd day of admission will result in a rejection or audit recovery.
Billing Tips
- If you are the Most Responsible Physician (MRP), ensure you append E083 or E084 to C169 to capture the 30% or 45% premium, as C169 alone does not reflect MRP status.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
All insured services must be documented in the medical record, establishing that the service was provided, is the service submitted for payment, and was medically necessary, as per .
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