C990 – First person seen - Hospital In-Patient
OHIP Surgical Procedures Code — GENERAL PREAMBLE · Schedule of Benefits
This is a 'first person seen' special visit premium for a non-elective visit to a hospital in-patient. A special visit is defined as a visit initiated by a patient or an individual on behalf of the patient for the purpose of rendering a non-elective service (as described in ). This premium applies when the service for the first patient seen commences on weekdays (Monday to Friday) during daytime hours (07:00-17:00). It must be claimed with an appropriate 'A' prefix assessment fee from the General Listings. The time of the visit must be documented in the medical record.
When to Use
- Use C990 when you are called to the hospital by nursing staff or a patient's family to assess an in-patient for a new, non-elective clinical issue during weekday business hours (07:00-17:00).
- Use this code when performing an urgent, non-elective assessment on an in-patient that is not part of your routine daily rounds or scheduled follow-up visits.
Common Pitfalls
- Billing C990 for routine daily rounds or scheduled follow-up visits will result in rejection, as the visit must be initiated by a specific request for a non-elective service.
- Failing to document the exact time of the visit in the patient's chart is a common audit failure that leads to full recovery of the premium fee.
- Submitting C990 alongside a subsequent visit code (e.g., C002) instead of an appropriate 'A' prefix assessment code (e.g., A007) will cause a billing error.
Billing Tips
- Ensure the 'A' prefix assessment code used with C990 reflects the complexity of the service provided, as the premium is an add-on to the base assessment fee.
- If you see multiple patients during the same trip, use C990 for the first patient and the appropriate 'subsequent' special visit premium (e.g., C991) for the others.
Effective: April 1, 2026
GP. General Preamble
GENERAL PREAMBLE
Premium
Special Visit Premiums (Table III - Hospital In-Patient)
The time at which the special visit takes place must be documented on the medical record.
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