C359 – Subsequent visit - after thirteenth week (maximum 6 per patient per month)
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A routine subsequent visit rendered by a urologist to a non-emergency hospital in-patient. This fee code applies specifically to visits occurring after the thirteenth week of admission. Per , a subsequent visit is any routine assessment in hospital following the hospital admission assessment and includes all specific elements of an assessment. The 'C' prefix signifies this service is for acute care hospital in-patients (). The time period is calculated from the patient's original admission date, regardless of transfers between physicians within the hospital.
When to Use
- Use C359 for routine daily rounds for a urology patient who has remained in the hospital for more than 91 days (13 weeks) from their original admission date.
- Use C359 when the patient has already exhausted the monthly limit for C358 (subsequent visits 5th to 13th week) and requires continued routine monitoring.
Common Pitfalls
- Billing C359 based on the date you assumed care rather than the patient's original hospital admission date, which often leads to premature use of this code.
- Exceeding the 6-visit-per-month limit without transitioning to C121 for documented acute intercurrent illnesses, resulting in automatic claim rejections.
- Failing to account for the patient's transfer history within the hospital, as the 13-week clock is continuous regardless of which physician is currently managing the patient.
Billing Tips
- If you are the Most Responsible Physician (MRP) and meet the remuneration criteria, always append E083 to C359 to capture the 30% premium for weekday visits.
- For weekend or holiday rounds on long-term patients, use E084 with C359 to increase the fee by 45% instead of the standard E083 premium.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
The time period for subsequent visits (e.g., 'after thirteenth week') is calculated from the patient's original hospital admission date, even if there is a transfer of care between physicians within the same hospital.
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