C238 – Concurrent care
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
C238 is defined as any routine assessment rendered in a hospital by a consultant physician following their initial major assessment of the patient. This service is appropriate when the patient's family physician remains the most responsible physician (MRP) but has requested continued directive care from the consultant due to the complexity of the case. As an assessment, this service includes the specific elements outlined in of the Schedule of Benefits, such as a direct physical encounter, taking a patient history, performing a physical examination, and arranging any necessary follow-up care.
When to Use
- Use C238 when you are the consultant providing ongoing directive care for a specific condition while the patient's family physician remains the Most Responsible Physician (MRP).
- Use this code for follow-up hospital visits after your initial consultation (A005 or equivalent) has been completed and the patient remains admitted under the care of another physician.
Common Pitfalls
- Billing C238 when you are acting as the MRP; if you have assumed responsibility for the patient's care, you must bill subsequent hospital visits (C002) instead.
- Exceeding the frequency limits of 4 visits in the first week and 2 visits per week thereafter, which will result in automatic claim rejections.
- Attempting to bill C238 on the same day as a major consultation (A005) or a transfer of care, as C238 is strictly for follow-up concurrent care.
Billing Tips
- Ensure your documentation clearly reflects the request for directive care from the MRP to justify why you are billing C238 rather than a standard follow-up visit.
- If the patient is in an ICU or CCU, remember to append the C101 premium to your C238 claim to capture the additional value for critical care environments.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
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