C268 – Paediatric concurrent care
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Concurrent care is any routine assessment rendered in hospital by the consultant following the consultant's first major assessment of the patient when the family physician remains the most responsible physician but the latter requests continued directive care by the consultant. This service is listed under the (Paediatrics) section of the Schedule, and is subject to the payment rules for Concurrent Care on .
When to Use
- Use C268 when you are the consultant providing ongoing directive care for a hospitalized paediatric patient while the family physician remains the Most Responsible Physician (MRP).
- Use this code for routine follow-up assessments in hospital after the initial consultation (C262) has been completed and the patient remains under your active, requested management.
Common Pitfalls
- Billing C268 beyond the weekly frequency limits (4 in the first week, 2 per week thereafter) will result in automatic rejection or recovery during audit.
- Claiming C268 when you are the MRP for the patient; if you have assumed responsibility for the patient's care, you must use subsequent visit codes like C265 instead.
- Attempting to attach a Special Visit Premium to C268; these premiums are strictly prohibited with 'C' prefix subsequent visit codes.
Billing Tips
- Ensure the medical record explicitly notes the request from the MRP for your continued directive care to satisfy the documentation requirements of GP48.
- If the patient is in an ICU or CCU, you may add the C101 premium to C268, provided no other team-based critical care fees are being claimed for that visit.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
Standard medical record requirements apply as per .
Must document the request for continued directive care from the Most Responsible Physician (MRP).
The C-prefix indicates this service is for non-emergency hospital in-patients.
For emergency calls and other special visits to in-patients, use General Listings ('A' prefix codes) and Premiums when applicable.
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