C489 – Subsequent visit - after thirteenth week
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A routine subsequent visit provided by a Rheumatologist to an acute care hospital in-patient, specifically for visits rendered after the thirteenth week following admission. A subsequent visit is any routine assessment in hospital following the hospital admission assessment. The limits on subsequent visits are one per patient, per day for the first 5 weeks, 3 visits per week from week 6 to 13, and 6 visits per month after week 13. When a hospital in-patient is transferred from one physician to another, subsequent visits by the second physician are calculated based on the original admission date of the patient. See .
When to Use
- Use C489 for routine, non-urgent follow-up assessments of a rheumatology inpatient occurring after the 13th week of their hospital stay.
- Use this code when the patient has already exhausted the weekly visit limits associated with C487 or C488 and requires continued routine monitoring.
Common Pitfalls
- Billing C489 for an acute intercurrent illness; these must be billed using C121 to avoid the monthly frequency limits of C489.
- Exceeding the limit of 6 visits per month after the 13th week, which will result in automatic claim rejections.
- Failing to account for the original admission date when a patient is transferred from another physician, leading to incorrect application of the 13-week threshold.
Billing Tips
- Always append the E083 premium if you are the Most Responsible Physician (MRP) and meet the hospital remuneration criteria to increase the C489 fee by 30%.
- If providing a routine visit on a weekend or holiday after the 13th week, use the E084 premium instead of E083 to capture the 45% increase.
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