C419 – Subsequent visit - after thirteenth week
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit is any routine assessment in hospital following the hospital admission assessment. C419 is a subsequent visit for a hospital in-patient, rendered by a physician in the specialty of Gastroenterology (41), after the thirteenth week of admission. For the purpose of determining the timeframe, the 'admission date' is considered the date the physician first assessed the patient, which may be different from the hospital admission date in cases of transfer of care. This service is subject to a maximum of six services per patient, per month. See for general rules on subsequent visits.
When to Use
- Use C419 for routine Gastroenterology follow-up assessments for an inpatient once the patient has exceeded the 13-week threshold from your initial assessment date.
- Use this code for long-term hospital patients where the care plan requires ongoing monitoring beyond the 91-day mark, provided you are the Gastroenterology specialist of record.
Common Pitfalls
- Billing C419 before the 91st day post-initial assessment; ensure you are using the correct code (e.g., C412 or C417) for earlier stages of the admission.
- Exceeding the maximum of six services per patient per month, which will trigger automatic rejections for any claims beyond this limit.
- Failing to bill C121 for acute intercurrent illnesses occurring on the same day as a C419 visit; C419 is restricted to one per day unless an acute event justifies an additional claim.
Billing Tips
- If you are the Most Responsible Physician (MRP) and meet the remuneration criteria, always append E083 to C419 to capture the 30% premium for routine weekday visits.
- If providing care in an ICU or CCU setting, remember to add the C101 premium to your C419 claim to increase the total service value.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
As an assessment, this service requires a direct physical encounter with the patient including taking a patient history and performing a physical examination. See for the full list of specific elements of an assessment.
The medical record must document the visit and support the ongoing need for care.
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