C262 – Subsequent paediatric visit - per visit
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit is any routine assessment in hospital following the hospital admission assessment. Pediatric subsequent visits (C262) are limited to one per patient, per day for the duration of the admission. This service includes the common elements of insured services as described in and the specific elements of assessments as described in .
When to Use
- Use C262 for routine daily inpatient follow-up assessments for pediatric patients (age 0-17) after the initial admission assessment has been completed.
- Use C262 when acting as the Most Responsible Physician (MRP) or a consulting specialist providing ongoing daily care to a hospitalized pediatric patient.
Common Pitfalls
- Billing C262 more than once per day for the same patient, as it is strictly limited to one claim per patient per day regardless of the number of times you visit the patient.
- Attempting to bill C262 alongside C121 (additional visits for intercurrent illness) on the same day, as these are mutually exclusive.
- Failing to document the Injury Severity Score (ISS) when attempting to apply the E420 trauma premium to a C262 visit, which will lead to a rejection.
Billing Tips
- If you are the MRP, ensure you append the E083 (weekday) or E084 (weekend/holiday) premium to C262 to increase the fee by 30% or 45% respectively, provided you meet the hospital remuneration criteria.
- When seeing a patient in the ICU or CCU, remember to add the C101 premium to your C262 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, Assessments
Pediatric patients
When a physician is already in the hospital and assesses one of his/her own patients or patients transferred to his/her care, the service constitutes a subsequent visit. If a physician assesses another physician’s patient on an emergency basis, the General Listings (“A” prefix) apply.
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