C172 – Subsequent visit - first five weeks
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit is a routine assessment of an acute care hospital in-patient, rendered by a Vascular Surgery specialist, following the hospital admission assessment and occurring within the first five weeks of admission. This service is defined in the General Preamble () and includes: - Multidisciplinary care scenarios where several physicians in different disciplines assess the patient. - Attendance at surgery if requested by the patient or their representative, where the physician does not assist. - The specific elements of an assessment as outlined in , including a direct physical encounter, history taking, physical examination, and provision of advice. - For subsequent visits after the first five weeks, see C177 and C179.
When to Use
- Use C172 for routine daily rounds on a vascular surgery inpatient during the first 35 days of their hospital stay.
- Use C172 when providing a follow-up assessment for a patient admitted under another service where you are providing vascular consultation or co-management within the first five weeks.
Common Pitfalls
- Claiming C172 alongside a special visit premium (e.g., K960) will result in a rejection; use an 'A' prefix code instead if the visit was specifically requested as an emergency.
- Billing C172 beyond the 35-day threshold post-admission; you must switch to C177 or C179 once the patient exceeds the five-week window.
- Attempting to add the MRP premium (E083/E084) to C172, which is ineligible for Vascular Surgery specialists.
Billing Tips
- If the patient is located in an ICU or CCU, remember to append the C101 premium to your C172 claim to capture the additional value for critical care settings.
- Ensure your documentation explicitly notes the physical examination findings to satisfy the GP15 requirement, as 'chart review only' does not qualify for a C-code assessment.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
All insured services must be documented in an appropriate medical record that establishes the service was provided, is the service for which the account is submitted, and was medically necessary. ()
As an assessment, the service must include a direct physical encounter with the patient including taking a patient history and performing a physical examination. ()
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