C319 – Subsequent visit - after thirteenth week
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit rendered to a non-emergency hospital in-patient by a specialist in Physical Medicine & Rehabilitation (31). This service is specifically for visits occurring after the thirteenth week of the patient's hospital stay. As per the definition, a subsequent visit is any routine assessment in hospital following the hospital admission assessment. This service is subject to a maximum of 6 visits per patient per month.
When to Use
- Use C319 for routine Physical Medicine & Rehabilitation assessments once the patient has exceeded 91 days (13 weeks) of continuous hospital admission.
- Use this code for long-term rehabilitation patients who require ongoing specialist oversight after the initial 13-week period has elapsed.
Common Pitfalls
- Billing C319 more than 6 times per calendar month, which will trigger automatic rejections or audit flags.
- Failing to account for the patient's original hospital admission date when calculating the 13-week threshold, leading to premature use of this code instead of C312 or C318.
- Attempting to bill special visit premiums (A-prefix) alongside C319, which is strictly prohibited for C-prefix hospital services.
Billing Tips
- If you are the Most Responsible Physician (MRP), ensure you append the E083 premium to C319 to capture the 30% increase, provided you meet the hospital remuneration criteria.
- Always verify the patient's admission date in the hospital chart to ensure the 13-week threshold has been met, as transfers between physicians do not reset the clock for the 13-week calculation.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
...after thirteenth week (maximum 6 per patient per month) per visit
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