C643 – Not found
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit is any routine assessment rendered in a hospital following the hospital admission assessment, performed by a specialist in General Thoracic Surgery (64). This service is applicable when the patient is an in-patient under the care of the specialist. According to the Schedule of Benefits, the definition of a subsequent visit includes: - Any routine assessment in hospital following the hospital admission assessment. - When the complexity of the medical condition requires the services of several physicians in different disciplines, each physician visit constitutes a subsequent visit. - Attendance at surgery by the referring physician, if requested by the patient or representative, when not assisting. This service uses a 'C' prefix code, indicating it is for non-emergency in-patient services in an acute care hospital.
When to Use
- Use C643 for routine daily follow-up assessments of an in-patient under your care in an acute care hospital after the initial admission assessment has been completed.
- Use C643 when you are providing a non-emergency assessment for a patient you are following in a multi-disciplinary care model where other specialists are also billing their own subsequent visit codes.
- Use C643 for a routine visit when you are the attending specialist and the patient is not in the immediate post-operative period of a procedure that includes global surgical care.
Common Pitfalls
- Billing C643 during the global post-operative period of a surgical procedure is a common audit trigger, as these visits are considered included in the surgical fee.
- Submitting C643 on the same day as an admission assessment (C642) for the same patient will result in an automatic rejection.
- Exceeding the frequency limits (1 per day for the first 5 weeks, then 3 per week, then 6 per month) will lead to non-payment for the excess claims.
Billing Tips
- If you are the Most Responsible Physician (MRP) and meet the specific remuneration criteria, always append E083 (or E084 on weekends/holidays) to maximize the value of the C643 claim.
- If a patient is transferred to your care, your first assessment is considered an admission assessment; use C643 only for subsequent visits following that initial transfer assessment.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
When a hospital in-patient is referred from one physician to another physician, the date the second physician assessed the patient for the first time is considered the “admission date” for the purposes of determining the appropriate subsequent visit fee code.
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