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Billing code

C169A — Nephrology hospital subsequent visit – after week 13

Nephrology hospital visit, week 14+

Bill C169 for a nephrologist's routine in-patient follow-up visit after the 13th week of admission.

Watch for: Maximum 6 per patient per month; bill extra visits for an acute intercurrent illness as C121.

Code

C169A

Description

Nephrology hospital subsequent visit – after week 13

FHO+ basket

Not in the FHO+ base rate basket (Schedule 2 or 2B).

Effective date

Apr 1, 2026

Termination date

No end date

Explanation

Updated October 26, 2026

Routine nephrology follow-up visit to a hospital in-patient after the thirteenth week of admission, up to 6 per patient per month.

What it covers

A hospital subsequent visit is any routine assessment in hospital after the admission assessment. When several physicians in different disciplines are needed, each physician's visit is a subsequent visit, except where a single team fee is listed, such as the weekly dialysis team fee (GP43).

C169 is the nephrology subsequent visit after the thirteenth week (A138).

Billing rules

• Maximum 6 per patient per month; visits over the limit are not payable (A138, GP43).
• Visits for an acute intercurrent illness beyond the monthly limit are C121, which the limits don't apply to (GP43).
• When an in-patient is referred to you, the date you first assess the patient counts as the admission date for choosing the subsequent visit code; after a transfer of care, count from the actual admission date (GP43).
• As the MRP, add E083 (+30%), or E084 (+45%) on Saturdays, Sundays and holidays; only one per patient per day, and only if hospital pay for in-patient work is absent or reduced accordingly (GP47).
• For chronic dialysis patients, admission assessments and subsequent visits to acute care in-patients for complications of dialysis, chronic renal disease or intercurrent illness are not included in the dialysis team fee and are billed separately (J39).
• Not listed in Appendix J, so it is not payable by video or telephone (A68, AJ1–AJ2).

Often billed with

• E083 or E084 MRP premium when you are the most responsible physician (GP47).

Common rejections

• AM1: More than 6 subsequent visits per patient per month were claimed after week 13 (A138, GP43).

Related codes: C167, C162, C121, C168, E083, E084

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Nephrology (16), page A138; rules GP43–GP47.

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