C467 – Subsequent Visit - Sixth to Thirteenth Week Inclusive
OHIP Surgical Procedures Code — Infectious Disease (46) · Schedule of Benefits
`C467 is a routine subsequent visit provided by an Infectious Disease specialist (46) to an in-patient in an acute care hospital. This service is for visits occurring from the sixth to the thirteenth week of the patient's hospital admission, inclusive. As a subsequent visit, it follows an initial admission assessment and includes all the common elements` (see , ) and specific elements of an assessment (see ). This involves a direct physical encounter with the patient, including a relevant history and physical examination, monitoring the patient's condition, providing advice, and arranging any necessary follow-up care or procedures.
When to Use
- Use C467 for routine, scheduled follow-up visits for an Infectious Disease inpatient between the 6th and 13th week of their hospital stay.
- Use this code when the patient's condition is stable or following a predictable trajectory, as opposed to an acute intercurrent illness requiring C121.
Common Pitfalls
- Billing C467 for an acute, unexpected change in patient status that requires a more intensive assessment; these should be billed as C121 instead.
- Attempting to attach a special visit premium to C467, which is prohibited as it is a routine hospital round visit.
- Incorrectly calculating the 6-13 week window, leading to rejections if the visit falls outside the specified timeframe for this code.
Billing Tips
- If you are the Most Responsible Physician (MRP) and meet the remuneration criteria, ensure you append E083 for weekday visits or E084 for weekend/holiday visits to maximize the claim value.
- If the patient is located in an ICU or CCU, remember to add the C101 premium to your C467 claim to account for the specialized setting.
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