C468 – Subsequent visits per month
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Concurrent care is any routine assessment rendered in hospital by the consultant following the consultant's first major assessment of the patient when the family physician remains the most responsible physician but the latter requests continued directive care by the consultant.
When to Use
- Use C468 when you have completed an initial consultation (A005/A007) and the family physician remains the MRP, but you are requested to provide ongoing, routine hospital management.
- Use C468 for daily or periodic hospital follow-ups where you are not assuming the role of MRP, distinguishing it from C002 which is for subsequent visits when you are the MRP.
Common Pitfalls
- Billing C468 when you have assumed the role of MRP; in this scenario, you must bill subsequent hospital visits (C002) instead.
- Exceeding the weekly frequency limits (4 in the first week, 2 thereafter) will result in automatic rejection of the excess claims.
- Billing C468 on the same day as a major assessment or consultation for the same patient, which is a common audit trigger for duplicate service claims.
Billing Tips
- Ensure the patient's chart clearly reflects the request from the MRP for continued directive care to justify the use of concurrent care codes over standard subsequent visit codes.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
Family physician remains the most responsible physician
Family physician requests continued directive care by the consultant
Definition: Concurrent care is any routine assessment rendered in hospital by the consultant following the consultant's first major assessment of the patient when the family physician remains the most responsible physician but the latter requests continued directive care by the consultant.
Payment rules: Claims for concurrent care are limited to 4 per week during the first week of concurrent care, and 2 claims per week thereafter. Services in excess of this limit are not eligible for payment.
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