C222 – Subsequent visit - first five weeks
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit is any routine assessment in a hospital following the hospital admission assessment, rendered by a physician with specialty code 22 (Genetics). The service includes all constituent and common elements of an assessment as outlined in the Schedule of Benefits. <br><br>As per the listing for C222 on page , this specific fee code is applicable for visits rendered within the first five weeks of the patient's admission. <br><br>According to the General Preamble (), a subsequent visit may also include attendance at surgery at the request of the patient or their representative (if not assisting), or care provided as part of a multidisciplinary team. When an in-patient is transferred between physicians, the 'admission date' for calculating visit frequency is based on the patient's actual hospital admission date, not the date of transfer to the new physician's care.
When to Use
- Use C222 for routine daily follow-up assessments by a Genetics specialist (code 22) for an inpatient within the first 35 days of their hospital admission.
- Use C222 when providing multidisciplinary care or attending surgery at the request of the patient or their representative, provided you are not acting as the surgical assistant.
Common Pitfalls
- Billing C222 beyond the 35-day window post-admission; after five weeks, you must transition to the appropriate long-stay subsequent visit code (e.g., C227).
- Assuming a new 35-day window begins upon transfer of care; the five-week count is strictly tied to the patient's original hospital admission date, regardless of when you assumed responsibility.
- Attempting to bill C222 in addition to C121 for the same patient on the same day; these are mutually exclusive unless specific intercurrent illness criteria are met.
Billing Tips
- If you are the Most Responsible Physician (MRP) and meet the remuneration requirements, always append the E083 premium to C222 to increase the claim value by 30%.
- Ensure your documentation explicitly justifies the medical necessity of the visit if you are billing C222 alongside other hospital-based services to avoid audit flags regarding service frequency.
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 that establish the service was provided, is the service for which the account is submitted, and was medically necessary.
The medical record requirements for assessments include a direct physical encounter, history, physical examination, and appropriate documentation of advice and arrangements made.
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