C997 – Additional person(s) seen
OHIP Surgical Procedures Code — GENERAL PREAMBLE · Schedule of Benefits
The C997 premium is for an additional person seen during a special visit to a hospital in-patient. A special visit is defined as a visit initiated by a patient or on their behalf for a non-elective service, as described on page . This premium applies when the service for the additional patient commences during the night hours, from 00:00h to 07:00h. It is paid in addition to the eligible assessment fee, which must be claimed using an 'A' prefix code from the General Listings.
When to Use
- Use C997 when you are already at the hospital for a primary special visit (e.g., C990) and are requested to see a second patient during the same night-time trip between 00:00 and 07:00.
- Apply this code when managing multiple non-elective, urgent in-patient assessments during a single call-out period to the hospital.
Common Pitfalls
- Billing C997 alongside an H-prefix code; this premium is strictly for in-patient hospital settings and is rejected if used for Emergency Department encounters.
- Attempting to claim a travel premium (e.g., C996) for each additional patient; only one travel premium is permitted per trip, regardless of the number of patients seen.
- Failing to document the exact start time of the assessment for the additional patient, which is a mandatory requirement for audit validation of the night-time window.
Billing Tips
- Ensure the primary patient is billed with the appropriate night-time special visit premium (e.g., C990) to establish the trip, then append C997 for each subsequent patient seen during that same visit.
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.
When a special visit service occurs in a hospital where common medical records are maintained, the time when the visit takes place may be documented anywhere in the common medical record.
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