C472 – Subsequent visit - first five weeks
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This service is for a routine assessment in a hospital for an admitted patient under the care of a specialist in Respiratory Disease. This code is applicable for visits rendered within the first five weeks of the patient's admission. A subsequent visit is defined as any routine assessment in hospital following the hospital admission assessment. It may also include attendance at surgery at the patient's request (if not assisting) or visits as part of multidisciplinary care. The service includes all common elements as defined in - and specific elements of an assessment as defined in , which cover history, examination, arranging further care, and communication with the patient.
When to Use
- Use for routine daily hospital assessments by a Respiratory Disease specialist for an admitted patient between day 2 and week 5 of the admission.
- Use for multidisciplinary care visits or attendance at surgery at the patient's request when you are not the Most Responsible Physician (MRP) and not acting as the surgical assistant.
- Use when providing follow-up care for a patient transferred to your service from another physician, provided the visit occurs within the first five weeks of the original hospital admission date.
Common Pitfalls
- Billing C472 on the day of admission, the day after, or the day of discharge when you are the MRP; these must be billed using MRP-specific codes C122, C123, or C124.
- Attempting to bill C472 in conjunction with special visit premiums (A-prefix codes), which will result in automatic rejection.
- Continuing to bill C472 beyond the five-week mark, which will trigger rejections; transition to C477 for weeks 6-13.
Billing Tips
- If you are the MRP, ensure you are billing the appropriate MRP-specific codes (C122-C124) to capture the correct fee and eligibility for the E083 or E084 premiums.
- Always verify the original hospital admission date when taking over a patient, as the five-week clock for C472 is tied to the admission date, not the date of your first consultation.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
first five weeks per visit
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.