C478 – Concurrent care
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
As per :, concurrent care is defined as any routine assessment rendered in a hospital by a consultant following the consultant's first major assessment of the patient. This service is applicable when the family physician remains the most responsible physician (MRP) but has requested continued directive care from the consultant. As an assessment, this service includes the specific elements outlined in :: - A direct physical encounter with the patient, including history and examination. - Making arrangements for related assessments, procedures, or therapy. - Discussion with, and providing advice and information to, the patient or their representative.
When to Use
- Use C478 for daily follow-up visits in the hospital when you are acting as a consultant and the patient remains under the care of an MRP who has requested your continued input.
- Use this code for routine inpatient assessments after your initial consultation (C002 or equivalent) has been completed and billed.
Common Pitfalls
- Billing C478 beyond the weekly frequency limits of 4 in the first week and 2 in subsequent weeks will trigger automatic rejections.
- Claiming C478 when you have assumed the role of MRP for the patient's hospital stay; in this case, you should bill subsequent hospital visits (C122, C123, or C124) instead.
- Failing to document the specific request from the MRP for continued directive care, which is a mandatory requirement for audit compliance.
Billing Tips
- If the patient is in an ICU or CCU, remember to append the C101 premium to your C478 claim to capture the additional value for those specific settings.
- Ensure your documentation clearly distinguishes the C478 visit from a 'Supportive Care' (C472) visit, as C478 requires active directive management rather than just monitoring.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
Medical record must document the request for continued directive care from the Most Responsible Physician (MRP).
As per the requirements for all assessments, the service, including history and examination findings, must be documented in the patient's medical record.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.