C229 – Subsequent genetic visit - after thirteenth week
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit provided by a Genetics specialist to a hospital in-patient after the thirteenth week of admission. As per , a subsequent visit is any routine assessment in hospital following the hospital admission assessment. In addition to the - common elements, all assessments include the following specific elements: - A direct physical encounter with the patient including taking a patient history and performing a physical examination. - Other inquiry (including taking a patient history), carried out to arrive at an opinion as to the nature of the patient's condition, (whether such inquiry takes place before, during or after the encounter during which the physical examination takes place) and/or follow-up care. - Performing any procedure(s) during the same encounter as the physical examination, unless the procedure(s) is(are) separately listed in the Schedule and an amount is payable for the procedure in conjunction with an assessment. - Making arrangements for any related assessments, procedures or therapy, and/or interpreting results. - Making arrangements for follow-up care. - Discussion with, and providing advice and information, including prescribing therapy to the patient or the patient's representative, whether by telephone or otherwise, on matters related to the service and results. - When medically indicated, monitoring the condition of the patient and intervening, until the next insured service is provided. - Providing premises, equipment, supplies, and personnel for the specific elements of the service except for any aspect(s) that is (are) performed in a hospital. Multidisciplinary Care: Except where a single service for a team of physicians is listed in this Schedule (e.g. the weekly team fee for dialysis), when the complexity of the medical condition requires the services of several physicians in different disciplines, each physician visit constitutes a subsequent visit ().
When to Use
- Use C229 for a routine hospital in-patient assessment by a Genetics specialist occurring on or after the 14th day of the patient's admission.
- Use this code when the patient has been transferred to your care, and the date of your first assessment is at least 14 days after the original hospital admission date.
Common Pitfalls
- Do not attempt to bill special visit premiums (e.g., K960 series) with C229, as 'C' prefix codes are strictly prohibited from being claimed with these premiums.
- Avoid using C229 for the initial consultation or the first visit following a transfer; use the appropriate 'C' prefix consultation code instead to ensure proper remuneration.
- Do not confuse the 14th day of your personal involvement with the 14th day of the patient's total hospital admission; the latter determines the eligibility for C229.
Billing Tips
- If you are the Most Responsible Physician (MRP) and meet the specific remuneration criteria, append E083 for weekday visits or E084 for weekend/holiday visits to increase the base fee.
- Ensure the patient's total length of stay in the hospital exceeds 13 days before claiming C229, as the code specifically applies to visits from the 14th day onwards.
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