C469 – Subsequent visit - infectious disease physician - long-term care institution
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit for a hospital in-patient, rendered by a physician with the specialty designation of Infectious Disease (46). This service is applicable for routine assessments rendered after the thirteenth week of a patient's continuous hospital stay. As per , a subsequent visit follows the initial hospital admission assessment and is part of the ongoing care for the patient. This service is limited to a maximum of six visits per patient per calendar month. This code is part of a timed sequence of subsequent visits for this specialty, following C462 (first five weeks) and C467 (sixth to thirteenth week).
When to Use
- Use for routine Infectious Disease follow-up assessments for patients who have exceeded 13 weeks of continuous hospital admission.
- Use when the patient has already exhausted the billing sequence for C462 (weeks 1-5) and C467 (weeks 6-13).
Common Pitfalls
- Billing C469 more than six times per calendar month, which will trigger automatic rejections for exceeding the monthly frequency limit.
- Attempting to bill C469 on the same day as C121; if an acute intercurrent illness occurs, you must bill C121 instead of the routine subsequent visit.
- Failing to track the patient's continuous hospital stay duration, leading to incorrect usage of C462 or C467 when C469 is the only valid code.
Billing Tips
- If you are the Most Responsible Physician (MRP), append E083 to the C469 claim to receive a 30% premium, provided you meet the remuneration criteria.
- Always reference the original hospital admission date when calculating the transition from C467 to C469, even if the patient was transferred to your care mid-stay.
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