C242 – Subsequent visit - first five weeks
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit by an Otolaryngologist for an in-patient during the first five weeks after admission. A subsequent visit is defined as any routine assessment in hospital following the hospital admission assessment. As per , this service includes a direct physical encounter with the patient, taking a patient history and performing a physical examination, making arrangements for any related assessments or therapy, discussion with the patient or their representative, and monitoring the patient's condition as medically indicated.
When to Use
- Use C242 for routine daily inpatient follow-up assessments performed by an Otolaryngologist within the first 35 days of the patient's hospital admission.
- Use C242 when managing an inpatient's recovery post-surgery, provided the visit occurs within the initial five-week window following the original admission date.
Common Pitfalls
- Billing C242 beyond the 35-day post-admission threshold; ensure you switch to C247 for weeks 6-13 and C249 thereafter.
- Attempting to bill C242 concurrently with a Special Visit Premium; for non-elective urgent assessments, you must use an A-prefix code (e.g., A244) instead of the C-prefix subsequent visit code.
- Incorrectly billing C242 when acting as the MRP for palliative care; ensure you are not using C122-C124 or C142/C143 when the patient is in a designated palliative care bed.
Billing Tips
- If you are the MRP, always append the E083 premium to C242 on weekdays or E084 on weekends/holidays to capture the 30% or 45% increase, provided you meet the eligibility criteria.
- If the patient is located in an ICU or CCU, remember to add the C101 premium to your C242 claim to capture the additional $9.10 fee.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
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