C487 – Subsequent visit - sixth to thirteenth week inclusive (maximum 3 per patient per week)
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit is any routine assessment in hospital following the hospital admission assessment, rendered by a physician with a specialty in Rheumatology (48). This specific code applies to visits during the sixth to thirteenth week of hospitalization, inclusive. As per , this service includes the specific elements of an assessment, such as a direct physical encounter, taking a patient history, performing a physical examination, making arrangements for related care, and providing advice to the patient or their representative. All common elements of insured services as described in and are also included.
When to Use
- Use C487 for routine rheumatology follow-ups for an admitted patient between the 6th and 13th week of their total hospital stay.
- Use this code when providing non-emergency, scheduled care for a patient who has already been assessed by the admitting physician or yourself during the current admission.
Common Pitfalls
- Billing C487 beyond the 3-visit-per-week limit will result in automatic rejection; use C121 only if an acute intercurrent illness requires an additional visit.
- Attempting to bill C487 on the same day as MRP-specific codes like C122 or C142 will trigger a rejection as they are mutually exclusive for the same physician.
- Calculating the 6-13 week window based on the date of transfer rather than the patient's original hospital admission date is a common audit error.
Billing Tips
- Ensure your billing software tracks the patient's total days in hospital from the original admission date to correctly transition from C486 to C487 and eventually C488.
- If you are the MRP, remember that C487 is not eligible for E083 or E084 premiums, as those are restricted to specific subsequent visit codes listed in the premium definitions.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
Applies to non-emergency hospital in-patient services.
Applicable from the sixth to the thirteenth week of admission, inclusive.
Maximum of 3 visits per patient per week.
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