C462 – Subsequent visit - hospital inpatient, or resident in a long-term care facility, or patient receiving home care, or patient in a correctional facility - by an infectious disease specialist
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit for an acute care hospital in-patient rendered by a specialist in Infectious Disease (46). This service is applicable for visits during the first five weeks of the patient's hospital stay. As defined in , a subsequent visit is any routine assessment in hospital following the hospital admission assessment. This may include: - Attendance at surgery if, in the interest of the patient, the referring physician is asked to be present by the patient or the patient's representative, but does not assist at the procedure. - In cases of multidisciplinary care where the complexity of the medical condition requires the services of several physicians in different disciplines, each physician visit constitutes a subsequent visit.
When to Use
- Use C462 for routine inpatient infectious disease follow-up assessments occurring within the first 35 days of the patient's hospital admission.
- Use C462 when providing multidisciplinary care where an infectious disease opinion is required, provided the patient is still within the first five weeks of their acute care stay.
Common Pitfalls
- Billing C462 after the 35-day mark; you must switch to C467 for weeks 6 through 13, or C469 thereafter, to avoid automatic claim rejection.
- Attempting to bill C462 on the same day as a psychiatric psychotherapy service for the same patient, which is restricted unless the services address entirely different diagnoses.
- Failing to account for the original hospital admission date when taking over a patient from another physician, as the 5-week window is based on the patient's admission date, not your first day of involvement.
Billing Tips
- If you are the Most Responsible Physician (MRP), append E083 for weekday visits or E084 for weekend/holiday visits to increase the C462 base fee, provided you meet the hospital remuneration eligibility criteria.
- Always add the C101 premium when performing the C462 assessment specifically within an ICU or CCU setting to capture the additional intensity of care.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
In addition to the common elements, all assessments must include documentation of: - A direct physical encounter with the patient including taking a patient history and performing a physical examination. - Other inquiry carried out to arrive at an opinion as to the nature of the patient's condition. - Arrangements for any related assessments, procedures or therapy, and/or interpreting results. - Arrangements for follow-up care. - Discussion with, and providing advice and information to the patient or the patient's representative.
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