C189 – Subsequent visit - after thirteenth week
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A routine assessment in a hospital following the hospital admission assessment, for a patient under the care of a Neurologist. This service is for visits occurring after the thirteenth week of admission and is limited to six visits per patient per month. As per , a subsequent visit is any routine assessment in hospital following the hospital admission assessment. This may include attendance at surgery at the patient's request (without assisting), or care by one of multiple specialists in cases of multidisciplinary care.
When to Use
- Use C189 for routine neurological assessments of a hospital inpatient once the patient has exceeded 91 days (13 weeks) from their original admission date.
- Use this code for multidisciplinary neurological follow-ups when you are not the Most Responsible Physician (MRP) but are providing ongoing specialist care.
Common Pitfalls
- Billing C189 before the 92nd day of admission will result in a rejection; ensure the date of service is strictly after the 13th week of the original admission.
- Exceeding the limit of six visits per patient per month will trigger automatic payment adjustments or rejections for the excess claims.
- Failing to account for the original admission date when a patient is transferred between services; the 13-week clock is based on the initial hospital admission, not the date of your specific involvement.
Billing Tips
- If you are the MRP and meet the criteria for E083 or E084, append these premiums to C189 to increase the claim value by 30% or 45% respectively.
- If the patient is located in an ICU or CCU, ensure you add the C101 premium to the C189 claim to capture the additional facility-based service fee.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable - see General Preamble to .
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