C411 – Complex medical specific re-assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
An assessment in hospital by a Gastroenterologist (specialty 41) required as a result of an acute intercurrent illness. This service is for visits in excess of the standard weekly or monthly limits for subsequent visits which apply after 5 weeks of continuous hospitalization. Per of the Schedule, standard subsequent visit limits are: - 3 visits per week from 6 to 13 weeks after admission. - 6 visits per month after 13 weeks. The limits on subsequent visits do not apply to 'additional visits due to intercurrent illness'.
When to Use
- Use C411 when a patient hospitalized for over 5 weeks develops a new, distinct acute condition (e.g., GI bleed or acute pancreatitis) requiring an additional visit that exceeds the weekly or monthly frequency limits defined in GP43.
- Use this code specifically for Gastroenterology (specialty 41) when the intercurrent illness necessitates a reassessment that would otherwise be rejected as a duplicate or frequency-limit violation under standard subsequent visit codes like C121.
Common Pitfalls
- Billing C411 for routine follow-up or chronic disease management in a long-stay patient, which does not meet the 'acute intercurrent illness' threshold required by GP43.
- Submitting C411 before the 5-week (35-day) threshold of continuous hospitalization has been reached, as standard subsequent visit codes apply prior to this period.
- Failing to clearly document the acute nature of the intercurrent illness in the progress notes, which creates an audit risk regarding the necessity of the visit in excess of standard limits.
Billing Tips
- Ensure your documentation explicitly links the visit to the new acute diagnosis to justify the 'intercurrent' nature of the service, distinguishing it from the patient's primary reason for admission.
- Remember that C411 is eligible for the E084 premium if the visit occurs on a weekend or holiday, provided you are the MRP.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
The code C411 represents the Gastroenterology (41) specific version of the generic 'additional visit due to intercurrent illness' service, analogous to C121 described in the General Preamble. The '41' in C411 indicates the specialty.
Per , subsequent visits are limited to one per day for the first 5 weeks, 3 per week from weeks 6 to 13, and 6 per month after 13 weeks. Visits for acute intercurrent illness are payable in excess of these limits after the first 5 weeks of hospitalization.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.