C619 – Subsequent Visit - After Thirteenth Week
OHIP Surgical Procedures Code — Haematology (61) · Schedule of Benefits
Subsequent visit to a hospital in-patient by a Haematologist after the thirteenth week of admission. This service is for subsequent visits after the thirteenth week of admission, with a maximum of 6 per patient per month. A subsequent visit is any routine assessment in hospital following the hospital admission assessment, as defined on . As per , this assessment includes a direct physical encounter with the patient, history taking, physical examination, arranging any related assessments or therapy, and providing advice to the patient or their representative. When the complexity of the medical condition requires the services of several physicians in different disciplines, each physician visit constitutes a subsequent visit.
When to Use
- Use for routine haematology follow-up assessments for patients who have been hospitalized for more than 13 weeks.
- Use when acting as a consulting haematologist providing ongoing care for a long-term inpatient, provided the 13-week threshold from the original hospital admission date is met.
Common Pitfalls
- Billing C619 before the 13-week mark; ensure the patient's total duration of hospitalization exceeds 13 weeks from the date of admission.
- Exceeding the maximum of 6 visits per month without documenting an acute intercurrent illness, which would otherwise require billing C121 for the additional visits.
- Incorrectly resetting the 13-week clock upon transfer; the 'admission date' for C619 is the patient's original hospital admission date, not the date of transfer to your service.
Billing Tips
- If you are the Most Responsible Physician (MRP), remember to append E083 to C619 to capture the 30% premium, provided you meet the hospital remuneration criteria.
- For visits exceeding the 6-per-month limit due to a new acute medical issue, use C121 for the extra visits to avoid rejection of the C619 claim.
Effective: June 1, 2025
Consultations and Visits
Haematology (61)
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
As per , an appropriate medical record must be maintained to establish that the service was provided, is the service for which the account is submitted, and was medically necessary.
Visits in excess of the monthly limit required as a result of an acute intercurrent illness are payable as C121 (additional visit due to intercurrent illness). The monthly limit does not apply to C121.
When a hospital in-patient is transferred from one physician to another, the date the second physician first assesses the patient is considered the 'admission date' for determining the appropriate subsequent visit fee code (C612, C617, or C619).
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