C993 – Additional person(s) seen
OHIP Surgical Procedures Code — GENERAL PREAMBLE · Schedule of Benefits
The C993 premium is for an 'additional person seen' during a special visit to a hospital in-patient. It is applicable under the following conditions: - The service is for an additional patient seen after the first patient during the same special visit trip. - The visit is non-elective. - The visit takes place on a weekday between 17:00 and 24:00. This premium is claimed in addition to an appropriate 'A' prefix assessment code and is subject to a daily maximum. The time of the visit must be documented in the patient's medical record as per .
When to Use
- Use C993 when you have already billed a C992 for the first patient and are subsequently asked to assess a second, different patient during the same non-elective hospital trip.
- Apply this code for the second through tenth patients seen during a single urgent hospital visit occurring between 17:00 and 24:00 on a weekday.
Common Pitfalls
- Billing C993 for patients seen in the Emergency Department, which is prohibited as C993 is strictly for hospital in-patients under Table III.
- Claiming C993 when the visit was elective or pre-scheduled, as the General Preamble strictly limits this premium to non-elective, urgent services.
- Exceeding the daily maximum of 10 total patients (first patient plus additional patients) for the same special visit time period.
Billing Tips
- Always pair C993 with an 'A' prefix assessment code (e.g., A007) to ensure the claim is processed correctly as a non-elective hospital service.
- Ensure the exact time of the visit is recorded in every patient's chart, as OHIP auditors frequently reject C993 claims that lack specific timestamp documentation.
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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