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C178

C178Concurrent care

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 this is an assessment, in addition to the common elements, this service includes the following specific elements: - A direct physical encounter with the patient including taking a patient history and performing a physical examination. - Other inquiry (including taking a patient history), carried out to arrive at an opinion as to the nature of the patient's condition, (whether such inquiry takes place before, during or after the encounter during which the physical examination takes place) and/or follow-up care. - Performing any procedure(s) during the same encounter as the physical examination, unless the procedure(s) is(are) separately listed in the Schedule and an amount is payable for the procedure in conjunction with an assessment. - Making arrangements for any related assessments, procedures or therapy, and/or interpreting results. - Making arrangements for follow-up care. - Discussion with, and providing advice and information, including prescribing therapy to the patient or the patient's representative, whether by telephone or otherwise, on matters related to the service. - When medically indicated, monitoring the condition of the patient and intervening, until the next insured service is provided. - Providing premises, equipment, supplies, and personnel for the specific elements of the service except for any aspect(s) that is (are) performed in a hospital.

When to Use

  • Use C178 when you have already performed an initial consultation (A005 or similar) and remain involved in the patient's care at the request of the MRP for ongoing management.
  • Use this code for daily or periodic hospital follow-up visits where you are providing directive care but are not the MRP for the admission.

Common Pitfalls

  • Billing C178 while simultaneously billing a consultation code (A-series) for the same patient on the same day will trigger an automatic rejection.
  • Attempting to attach a special visit premium (e.g., K963) to C178 is a common audit trigger, as concurrent care is explicitly excluded from premium eligibility under GP65.
  • Billing C178 when you have assumed the role of MRP; in this scenario, you must switch to subsequent hospital visit codes (C002) instead.

Billing Tips

  • Ensure the referring physician's billing number is included in the claim to satisfy the referral requirement for concurrent care.
  • If you are providing multiple services on the same day, prioritize the highest-value assessment or procedure, as C178 is a routine assessment that does not stack with other visit codes.
Provider Fee$0.00
Specialist Fee$31.00

Effective: June 1, 2025

Category

A. Consultations and Visits

Subcategory

CONSULTATIONS AND VISITS

Service Type

Assessment

Code Classes

Hospital and Institutional Consultations and Assessments

Referral RequiredFrom: Physician

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