C227 – Subsequent visit - sixth to thirteenth week inclusive (maximum 3 per patient per week)
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This service is a routine assessment rendered by a Genetics specialist to a non-emergency hospital in-patient following the admission assessment. Per the listing on page , this code is specifically for visits that occur from the sixth to the thirteenth week of admission, inclusive. A subsequent visit is defined on page as any routine hospital assessment following the hospital admission assessment. It can also include attendance at a surgery at the request of the patient (if the physician does not assist) or visits by different specialists for a patient with complex medical conditions.
When to Use
- Use C227 for routine follow-up assessments by a Genetics specialist for an inpatient between day 36 and day 91 of their admission.
- Use this code when providing routine care for a patient with complex genetic conditions who remains hospitalized beyond the initial 5-week period covered by C222.
Common Pitfalls
- Billing more than 3 visits per week will result in automatic rejection of the excess claims.
- Using C227 for an acute intercurrent illness instead of C121, which is the required code for non-routine, episodic care.
- Failing to track the admission date accurately, leading to claims for C227 before the 6-week threshold or after the 13-week threshold (where C229 would apply).
Billing Tips
- If you are the MRP, ensure you append E083 or E084 to the C227 claim to capture the 30% or 45% premium, provided you meet the hospital remuneration criteria.
- If the patient is in an ICU or CCU, remember to add the C101 premium to your C227 claim to maximize the value of the visit.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.