C179 – Subsequent visit - after thirteenth week
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This service is a subsequent visit by a Vascular Surgery specialist to a hospital in-patient, applicable for visits rendered after the thirteenth week of admission. A subsequent visit is defined as any routine assessment in a hospital following the hospital admission assessment. Per the General Preamble (), when the complexity of a patient's condition requires services from multiple physicians in different disciplines, each physician's visit constitutes a subsequent visit. If a hospital in-patient is transferred between physicians, the 'admission date' for calculating visit frequency is considered the date the second physician first assessed the patient.
When to Use
- Use for routine hospital in-patient assessments by a Vascular Surgeon once the patient has exceeded 13 weeks of continuous admission.
- Use when managing long-term vascular patients who have transitioned past the 13-week threshold, provided the visit does not qualify for C121 due to an acute intercurrent illness.
Common Pitfalls
- Billing C179 before the 13-week mark; ensure the admission date is accurately tracked to avoid automatic rejections for incorrect visit frequency.
- Exceeding the maximum of 6 visits per month for this code; any visits beyond this limit require a specific clinical justification or a different code if an acute intercurrent illness (C121) is present.
- Failing to account for the original admission date upon patient transfer; the 13-week clock is tied to the patient's total hospital stay, not the date the Vascular Surgeon assumed care.
Billing Tips
- If the patient develops an acute intercurrent illness requiring additional visits beyond the 6-per-month limit, use C121 instead of C179 to bypass the frequency restriction.
- Always verify if you qualify as the Most Responsible Physician (MRP) to append the E083 or E084 premium, as these significantly increase the value of the C179 service.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
In accordance with the specific elements of assessments outlined in , documentation must include a patient history and physical examination.
The patient's medical record must allow for tracking of the admission date to confirm eligibility for this service, which begins after the 13th week of admission.
Subsequent visits after thirteenth week (maximum 6 per patient per month) per visit.
The limits on subsequent visits (one per day, 3 per week from weeks 6-13, 6 per month after week 13) do not apply to additional visits due to an acute intercurrent illness, which are claimed as C121.
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