C412 – Subsequent visit - first five weeks
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit is any routine assessment in hospital following the hospital admission assessment. This specific code, C412, is for a subsequent visit rendered by a Gastroenterologist (specialty 41) to an acute care hospital in-patient during the first five weeks of their admission. As defined in , a subsequent visit includes: - Attendance at surgery if the physician is asked to be present by the patient or their representative but does not assist at the procedure. - Visits as part of multidisciplinary care, where the complexity of the patient's condition requires the services of several physicians in different disciplines. When a hospital in-patient is referred from one physician to another, the date the second physician assesses the patient for the first time is considered the 'admission date' for determining the appropriate subsequent visit fee code.
When to Use
- Use for routine daily inpatient rounds for a Gastroenterology patient during the first 35 days of their hospital stay.
- Use for a Gastroenterology consult follow-up visit when you are not the Most Responsible Physician (MRP) but are providing ongoing specialist care.
- Use when attending a surgery as a non-assisting physician at the request of the patient or their representative.
Common Pitfalls
- Billing C412 after the 35th day of admission; you must switch to C417 (subsequent visit after five weeks) once the 36th day is reached.
- Billing C412 when you are the MRP and eligible for the E083 premium; failing to attach the premium results in lost revenue.
- Attempting to bill C412 on the same day as a consultation code (e.g., A415) for the same patient; the consultation fee generally supersedes the subsequent visit fee.
Billing Tips
- Always verify the patient's original admission date to the hospital, as your 'five-week' clock starts from that date, not the date of your first specialist assessment.
- If you are the MRP, ensure you append E083 for weekday visits or E084 for weekend/holiday visits to maximize the base C412 fee.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
All insured services must be documented in an appropriate medical record that establishes that the service was provided, is the service submitted for payment, and was medically necessary, as per .
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