1What Is the C025 OHIP Code?
C025 is an OHIP billing code specifically used for dermatological consultations for hospital in-patients in Ontario. This code is applied when a dermatologist is asked to provide an expert opinion on complex cases, such as identifying a rash, assessing a drug eruption, or evaluating a non-healing ulcer. These cases require the dermatology service's specialized knowledge to assist the ward team in patient management.
Consultations under C025 require a formal written request from a referring physician, nurse practitioner, or dental surgeon for a consultation based on their professional judgment. It includes providing a comprehensive report back to the referring entity, detailing findings and recommendations.
This code can often be missed if the referral documentation is incomplete or if the consultation does not meet the specific criteria outlined in the OHIP guidelines, which emphasize the importance of appropriate referrals and record-keeping.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A021 | A021 Advanced Dermatology Consultation | Varies based on need for advanced consultation | Used for complex dermatological cases requiring advanced assessment. |
| A025 | A025 Consultation | Once per 12 months for out-patient consultations | Used for consultations in non-hospital settings. |
| A026 | A026 Repeat consultation | Based on specific criteria for repeat consultations | Applies to follow-ups necessitating a repeated evaluation. |
| A027 | A027 Consultation in association with special visit | Varies per service requirements | Applicable for consultations tied to special hospital visit circumstances. |
3Eligibility Requirements
To be eligible for billing under code C025, the consultation must meet specific criteria:
- The consultation must be rendered following a written request from a referring physician, nurse practitioner, or dental surgeon. This request should identify the consultant by name and specialty, as well as include the name and billing number of the referring entity and the patient's identifying information.
- The request must outline sufficient details pertinent to the consultation, specifying the service(s) required.
- A copy of the written request must be kept in the dermatologist's records, except when common records are maintained within hospital or multi-specialty clinic settings.
- Consultations are limited to one service per two consecutive 12-month periods for the same patient and diagnosis, with some exceptions allowing for a second service in that period when provided as an inpatient or emergency department consultation more than 12 but less than 24 months after the first.
- Consultation requests initiated after the service has been delivered will not be eligible under this code.
4What Your Clinical Note Must Show
Proper documentation is essential for C025 billing.
- Maintain a copy of the written consultation request.
- Include the consultant's name and specialty in the request.
- Record the referring physician's name and billing number.
- Capture patient details: name and health number.
- Document time spent: start and end times of the consultation.
5Weak vs. Strong Note Examples
The strong note provides explicit detail on the referring practitioner, the patient's condition, and consultation specifics, including time tracking. The weak note lacks a formal referral and complete information, which fails to meet OHIP billing requirements.
Date: 2023-10-12. Consult requested. No referral attached. Patient has a rash. Seen in 20 min.
Date: 2023-10-12. Consultation completed as per request from Dr. Smith, GP (Billing #123456). Detailed evaluation of patient's 3-day rash performed, differential diagnosis provided. Assessment duration 09:00 to 09:30.
- Copy of Dr. Smith's request filed in patient record.
- Consultation findings and recommendations documented.
