C417 – Subsequent visit - sixth to thirteenth week inclusive (maximum 3 per patient per week)
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit for a hospital in-patient, rendered by a physician with a specialty in Gastroenterology (41). According to on , a subsequent visit is any routine assessment in hospital following the hospital admission assessment. This specific fee code applies to visits rendered during the sixth to thirteenth week of admission, inclusive. The service is limited to a maximum of three visits per patient per week.
When to Use
- Use C417 for routine daily hospital rounds for a Gastroenterology patient between day 36 and day 91 of their continuous hospital admission.
- Use C417 when managing stable chronic GI conditions (e.g., long-term TPN management or slow-healing fistulas) during the 6th to 13th week of stay.
- Use C417 as the base code for the MRP premium E083 when the patient has exceeded the 5-week threshold for standard subsequent visit codes.
Common Pitfalls
- Billing more than 3 instances of C417 per rolling 7-day period will result in automatic rejection; use C121 only if a distinct intercurrent illness occurs.
- Attempting to bill C417 during the first 5 weeks of admission is a common error; those weeks require different subsequent visit codes (e.g., C412).
- Failing to account for the 13-week limit; once the patient exceeds 13 weeks, you must transition to long-stay codes like C419.
Billing Tips
- If you are the MRP, always append E083 to C417 to capture the 30% premium, provided you meet the hospital remuneration requirements.
- If a patient develops an acute, unrelated issue (e.g., new onset pneumonia) during this period, bill C121 for that specific visit to bypass the 3-visit-per-week limit of C417.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
maximum 3 per patient per week
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