1What Is the C005 OHIP Code?
What is OHIP Billing Code C005?
The OHIP Billing Code C005 is used by family physicians to bill for consultations. It is applicable when another physician seeks a family physician's expert opinion regarding an admitted hospital patient. These consultations often involve assessing the patient’s community context or discussing their management post-discharge.
Physicians must remember that consultations are typically required as a result of written requests from another physician. As these interactions can significantly influence a patient's continued care and management after discharge, capturing these details meticulously can impact billing accuracy.
This code may often be overlooked if detailed documentation and context for the consultation request are not maintained, which is crucial for successful billing under C005.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A914 | GP focused practice comprehensive consultation by Video | N/A | $247.40 fee for comprehensive video consultation. |
| A006 | Repeat consultation | N/A | $47.10 fee for repeat consultations. |
| A010 | GP focused practice consultation by Video | N/A | $95.60 fee for focused practice video consultations. |
| A011 | GP focused practice repeat consultation by Video | N/A | $47.10 fee for repeat video consultations. |
3Eligibility Requirements
Eligibility for C005
- Frequency: Limited to one service per two consecutive 12-month periods per patient, per physician, per diagnosis. Exceptions exist: two services in two consecutive 12-month periods can be billed if the second is for a hospital inpatient or Emergency Department visit, more than 12 months but less than 24 months after the first service.
- Unrelated Diagnosis: One service every 12 months is allowed if the diagnosis is clearly unrelated.
- Excess Services: If billed more frequently, will be reimbursed at general or specific assessment rates.
4What Your Clinical Note Must Show
Ensure documentation includes the following:
- A written request from the referring physician.
- Detailed notes regarding the consultation.
- Clinical context, community context, or patient management strategies discussed.
5Weak vs. Strong Note Examples
The strong note succeeds because it clearly outlines the consultation's context, referrer's details, and recommendations made, which are essential for validating the service.
Consulted on patient A. Discussed possible management post-discharge.
Dr. Smith requested our consultation on Mr. A's management due to his complex community living situation. Reviewed patient's medical history and recommended continuation of current treatment post-discharge with community support.
- Explicit mention of the referring physician.
- Specifics of patient’s community context and management plan.
