C209 – Subsequent visit - after thirteenth week
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit is any routine assessment in hospital following the hospital admission assessment, as defined in . This service, C209, is rendered by a specialist in Obstetrics and Gynaecology (20) for an in-patient after the thirteenth week of their hospital stay. As per , this assessment includes a history of the presenting complaint, physical examination, advice to the patient, and maintaining an appropriate record. This service is limited to a maximum of six visits per patient per month.
When to Use
- Use C209 for routine hospital follow-up visits by an Obstetrician/Gynaecologist (specialty 20) once the patient has exceeded 91 days (13 weeks) of continuous hospitalization.
- Use C209 when the patient is stable and does not require the intensive management associated with C121, provided the monthly limit of six visits has not been reached.
Common Pitfalls
- Billing C209 before the 92nd day of hospitalization will result in automatic rejection as the code is strictly reserved for long-stay patients.
- Exceeding the maximum of six visits per patient per month will lead to claim denials; any necessary visits beyond this limit for acute issues must be billed as C121.
- Attempting to claim E083 or E084 with C209 is a common error, as these MRP premiums are explicitly restricted to the specific codes listed in their respective fee schedule descriptions.
Billing Tips
- Ensure your hospital admission date is accurately reflected in your billing software to trigger the transition from standard subsequent visit codes to C209 after the 13-week threshold.
- If the patient develops an acute intercurrent illness requiring more than six visits in a month, bill the additional visits using C121 and ensure the clinical record clearly justifies the acute nature of the service.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
after thirteenth week (maximum 6 per patient per month) per visit
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