C479 – Subsequent visit after thirteenth week
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A routine subsequent visit by a Respiratory Disease (47) specialist for an in-patient of an acute care hospital. This service is for ongoing care and is applicable only after the thirteenth week of hospitalization. As an assessment, this service includes the required specific elements as defined in the General Preamble, such as history, examination, and providing advice to the patient. This visit is subject to a maximum of six services per patient per month. See General Preamble for general rules on subsequent visits.
When to Use
- Use C479 for routine, ongoing respiratory management of a patient who has been hospitalized for more than 13 weeks.
- Use C479 when the patient is stable and does not require the intensive management associated with an acute intercurrent illness (which would require C121).
Common Pitfalls
- Billing C479 before the 13-week threshold has been reached, which will trigger an automatic rejection.
- Attempting to bill C479 on the same day as admission-related codes like C122, C123, or C124, which are restricted.
- Exceeding the maximum of six services per patient per month, which will result in the denial of claims beyond the limit.
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 increase the fee by 30% or 45% respectively.
- If the patient is located in an ICU or CCU, remember to add the C101 premium to the C479 base fee to capture the additional complexity of the setting.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
See General Preamble to .
For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable - see General Preamble to .
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