C207 – Subsequent visit - sixth to thirteenth week inclusive
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Represents a routine assessment for a non-emergency, acute care hospital in-patient provided by an Obstetrician/Gynaecologist. This service is applicable for visits occurring between the sixth and thirteenth week (inclusive) of the patient's hospitalization. As defined in , a subsequent visit is any routine assessment following the hospital admission assessment. It includes all specific elements of an assessment as outlined in , such as a direct physical encounter, history taking, physical examination, and arranging for follow-up care.
When to Use
- Use C207 for routine inpatient assessments occurring between the 43rd and 91st day of a continuous hospital admission.
- Use C207 when the patient is stable and does not require an additional visit for an acute intercurrent illness (which would be billed as C121).
Common Pitfalls
- Billing more than 3 units of C207 per rolling week, which will trigger automatic rejection by the Ministry.
- Attempting to bill C207 when the patient has been hospitalized for fewer than 6 weeks, where C202 is the correct code.
- Billing C207 on the same day as MRP-specific subsequent visit codes (e.g., C122, C123) if you are not the designated MRP.
Billing Tips
- If an acute intercurrent illness occurs after the 5th week, bill C121 for the acute assessment instead of C207 to bypass the 3-visit-per-week limit.
- Ensure your documentation clearly reflects the date of admission to justify the transition from C202 to C207 and eventually to C209.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
All insured services must be documented in appropriate records to establish that the service was provided, was medically necessary, and is the service claimed. A subsequent visit includes a direct physical encounter with the patient, taking a history, performing a physical examination, and appropriate record keeping.
Subsequent visits are limited based on the duration of hospitalization: one per patient, per day for the first 5 weeks after admission (C202), 3 visits per week from 6 to 13 weeks after admission (C207), and 6 visits per month after 13 weeks (C209). Services in excess of these limits are not eligible for payment.
After 5 weeks of hospitalization, any assessment in hospital required as a result of an acute intercurrent illness in excess of the weekly or monthly limits constitutes C121: 'additional visit due to intercurrent illness'. The weekly or monthly limits do not apply to C121.
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