C239 – Subsequent visit - after thirteenth week
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit for a non-emergency in-patient of an acute care hospital, rendered by a physician in the specialty of Ophthalmology (23). This service is specifically for routine assessments following the hospital admission assessment, occurring after the thirteenth week of the patient's hospital stay. As per , a subsequent visit includes any routine assessment in hospital following the hospital admission assessment. It also encompasses the specific elements of assessments outlined in . Visits for acute intercurrent illness that exceed the monthly limit should be claimed as C121. For emergency calls or other special visits, General Listings ('A' prefix codes) and special visit premiums should be used instead, as noted on .
When to Use
- Use C239 for routine ophthalmological assessments of an inpatient who has remained in the acute care hospital for more than 13 weeks.
- Use C239 when the patient's condition is stable and does not require the additional intercurrent illness billing associated with C121.
Common Pitfalls
- Billing C239 for patients hospitalized for less than 13 weeks; you must use C232 for the first 5 weeks and C237 for weeks 6 through 13.
- Exceeding the monthly limit of 6 visits per patient; any subsequent visits beyond this limit are rejected unless they qualify as C121 for acute intercurrent illness.
- Attempting to bill a special visit premium with C239; 'C' prefix codes are ineligible for premiums, which must be billed with 'A' prefix codes instead.
Billing Tips
- If you are the Most Responsible Physician (MRP) and meet the remuneration criteria, ensure you append E083 for weekday visits or E084 for weekend/holiday visits to maximize the C239 fee.
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