C197 – Subsequent Visit
OHIP Surgical Procedures Code — Psychiatry (19) · Schedule of Benefits
A routine assessment of a hospital in-patient following the admission assessment, rendered by a psychiatrist. This service is specifically for visits that occur from the sixth to the thirteenth week of hospitalization, inclusive. As per the General Preamble (), a subsequent visit is any routine assessment in the hospital. The 'C' prefix indicates this service is for non-emergency, in-patient hospital care ().
When to Use
- Use C197 for routine psychiatric follow-up assessments specifically between the 36th and 91st day (inclusive) of an inpatient admission.
- Use C197 when the patient has transitioned past the initial five-week window covered by C192 but has not yet reached the long-term stay threshold of C199.
Common Pitfalls
- Billing more than three C197 units per week will trigger automatic rejections, as the schedule strictly limits frequency regardless of clinical necessity.
- Failing to track the original admission date when assuming care from another physician often leads to using the wrong code in the C192-C197-C199 sequence.
- Attempting to bill C197 alongside C121 for the same patient on the same day will result in a rejection, as C121 is reserved for acute intercurrent illnesses only.
Billing Tips
- If you are the Most Responsible Physician (MRP) and meet the remuneration criteria, always append E083 for weekday visits or E084 for weekend/holiday visits to maximize the C197 base fee.
- Ensure your billing software or manual tracking system flags the transition from C192 to C197 at the start of the sixth week to avoid audit discrepancies.
Effective: June 1, 2025
Consultations and Visits
Psychiatry (19)
Assessment
Hospital and Institutional Consultations and Assessments
sixth to thirteenth week inclusive (maximum 3 per patient per week) per visit
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