1What Is the C015 OHIP Code?
C015 is a billing code used by anesthesiologists in Ontario for consultations conducted on hospital in-patients. This typically involves a pre-operative assessment for patients with complex medical conditions, such as those with a difficult airway history or unstable comorbidities. It is important to note that routine pre-anaesthetic evaluations, as mandated under the Public Hospitals Act, do not qualify for billing with this code.
Consultations under C015 are crucial when the complexity, seriousness, or specific needs of the case demand a specialized anesthetic opinion. These consultations are billed at a flat rate of CAD 109.70 and can significantly impact patient outcomes by ensuring that anesthesia plans are tailored to the patient's unique medical needs.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A015 | Consultation | Equivalent service outside hospital in-patient settings | Same fee as C015; for use in non-hospital settings. |
| A016 | Repeat consultation | As needed, with frequency limits observed | Lower fee repeat consultations when certain criteria are met. |
| A210 | Special anaesthetic consultation | As needed, with fee guidelines | Higher fee for detailed anesthetic consultations. |
| A215 | Limited consultation for acute pain management | In association with hospital in-patient visits | For acute pain management consults. |
3Eligibility Requirements
To be eligible to bill using C015, a written request for a consultation must be received from a physician, nurse practitioner, or dental surgeon for an insured dental procedure in a hospital, who is familiar with the patient. The consultation must involve an assessment made in response to the complexity or seriousness of the case, requiring the expertise of an anesthesiologist.
The consulting anesthesiologist must keep a copy of the consultation request in the patient's medical record, except in settings where common medical records are maintained, such as hospitals or multi-specialty clinics. The request must clearly identify the consultant, referring practitioner, and patient by their respective names and identifiers.
Consultations are limited to one service per two consecutive 12-month periods for the same patient and diagnosis, except in situations where the second consultation is conducted on a hospitalized in-patient more than 12 but less than 24 months after the first. When the requests exceed these limits, the consultation fees revert to general or specific assessment rates.
4What Your Clinical Note Must Show
The consulting anesthesiologist must document:
- A complete written request for the consultation, signed by the referring practitioner.
- The specific details of the referral, setting out relevant information and required services.
- The identification of the consultant, referring practitioner, and patient by name and identifier.
- A written report with findings, opinions, and recommendations sent to the referring practitioner.
5Weak vs. Strong Note Examples
The strong note succeeds due to its comprehensive detailing of the patient's condition, explicit recommendations, and proper documentation of communication with the referring practitioner. Meanwhile, the weak note lacks precise details and fails to demonstrate the complexities of the case.
Consultation performed. Discussed possible anesthesia approaches. No specific findings noted.
Consultation requested by Dr. Smith for Mr. Jones, a 70-year-old male with an unstable comorbidity and history of difficult airway. Thorough pre-operative assessment completed on 12th October 2023:
Findings: Increased risk due to airway and cardiovascular instability.
Recommendations: Tailored anesthetic plan proposed to manage airway difficulties.
Communication: Written report forwarded to Dr. Smith including all recommendations and risks discussed.
- Correctly identified all parties involved, including the date.
- Included specific findings and detailed recommendations.
- Outlined all communication exchanged with the referring practitioner.
