C237 – Subsequent visit - sixth to thirteenth week inclusive
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit as defined in the Schedule of Benefits (), rendered by a physician with specialty designation in Ophthalmology (23). This service is a routine assessment in hospital following the hospital admission assessment for a non-emergency in-patient. This service applies specifically to visits occurring during the sixth to the thirteenth week of hospitalization, inclusive. It is limited to a maximum of 3 visits per patient per week (). As an assessment, this service includes all common elements of insured services (, ) and the following specific elements (): - A direct physical encounter with the patient including taking a patient history and performing a physical examination. - Making arrangements for any related assessments, procedures or therapy, and/or interpreting results. - Discussion with, and providing advice and information, including prescribing therapy to the patient or the patient's representative. - When medically indicated, monitoring the condition of the patient and intervening, until the next insured service is provided.
When to Use
- Use C237 for routine inpatient ophthalmology follow-ups occurring between day 36 and day 91 of the patient's continuous hospital admission.
- Use this code when the patient has already exhausted the initial visit frequency limits covered by C232 (first week) or C239 (second to fifth week).
Common Pitfalls
- Billing C237 beyond the 3-visit-per-week limit without documenting an acute intercurrent illness to justify C121, which will lead to automatic payment rejection or adjustment.
- Using C237 for patients transferred to your care; you must calculate the visit week based on the patient's original hospital admission date, not the date of transfer to your service.
Billing Tips
- If you are managing a patient in the ICU or CCU during this timeframe, ensure you append the C101 premium to the C237 claim to capture the additional value for intensive care settings.
- Always verify the patient's total length of stay in the hospital record before coding, as billing the wrong 'C' series code (e.g., C239 vs C237) is a frequent audit trigger for ophthalmologists.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
- sixth to thirteenth week inclusive (maximum 3 per patient per week) per visit
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