C342 – Subsequent visit - first five weeks
OHIP Surgical Procedures Code — RADIATION ONCOLOGY (34) · Schedule of Benefits
This code is for a routine subsequent assessment by a Radiation Oncologist for a non-emergency hospital in-patient during the first five weeks of their hospital stay. A subsequent visit is any routine assessment in hospital following the hospital admission assessment, as defined on . This includes attendance at surgery if requested by the patient and care provided as part of a multidisciplinary team. It is limited to one per day. For visits after the first five weeks, see C347 and C349.
When to Use
- Use C342 for routine daily assessments of a hospital in-patient by a Radiation Oncologist during the first 35 days of their admission.
- Use C342 when attending surgery as a consultant if requested by the patient, provided it is the only assessment performed that day.
- Use C342 for multidisciplinary team care visits where the Radiation Oncologist provides a formal assessment of the patient.
Common Pitfalls
- Billing C342 beyond the 35-day limit; ensure you switch to C347 starting on day 36 to avoid automatic rejections.
- Attempting to claim C342 in conjunction with Special Visit Premiums; these are mutually exclusive and will result in claim denial.
- Billing C342 on the same day as an MRP-specific subsequent visit (e.g., C122, C142) for the same patient, which violates the restriction against duplicate assessment fees.
Billing Tips
- If you are the Most Responsible Physician (MRP) and meet the remuneration requirements, append E083 or E084 to your C342 claim to increase the fee by 30% or 45% respectively.
- When a patient is transferred to your care, your first assessment date resets the 5-week clock for C342, regardless of how long the patient was previously hospitalized under another physician.
Effective: June 1, 2025
A. Consultations and Visits
RADIATION ONCOLOGY (34)
Assessment
Hospital and Institutional Consultations and Assessments
All insured services must be documented in appropriate records that establish: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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