1What Is the C055 OHIP Code?
C055 is an OHIP billing code designed explicitly for Community Medicine consultations, typically used in settings such as hospitals where inpatients are assessed for communicable diseases or exposures that might impact other patients and staff.
In practice, this consultation involves the evaluation of the patient's condition, followed by a comprehensive written report submitted to the referring healthcare professional. This process is critical when the case complexity requires specialized knowledge that the consulting physician possesses.
Due to procedural and documentation requirements, C055 might be missed if the consultation request isn't correctly documented, or if the consultation doesn't meet the criteria for a complex assessment.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A050 | Special community medicine consultation | Frequency varies based on case complexity | For more complex consultations in community settings with a fee of $176.10. |
| A055 | Consultation | Similar frequency as C055 but outside hospital in-patient settings | Equivalent to C055 for consultations performed outside inpatient settings, billing at $152.80. |
| A056 | Repeat consultation | Frequency as permissible by standard limits | Used for follow-up consultations if eligibility criteria are met, at $94.75. |
| A400 | Comprehensive community medicine consultation | Based on case criteria and necessity, less frequent | Covers extensive cases requiring comprehensive assessment, at $270.60. |
3Eligibility Requirements
Eligibility Requirements for Billing C055
- Setting: Only eligible in non-emergency hospital in-patient services under the Community Medicine listing.
- Consultation Conditions:
- Must be initiated by a written request from a referring physician, nurse practitioner, or dental surgeon linked to an insured dental procedure in a hospital.
- The consultation must address complexities warranting the opinion of a consultant physician in Community Medicine.
- Documentation Required:
- A copy of the written request must be maintained in the consultant physician's medical records.
- The request should identify the consultant by name or specialty, and include the referring professional's details and billing number along with the patient's information.
- Eligibility for repeat consultations or within certain timeframes should be carefully considered.
4What Your Clinical Note Must Show
Accurate documentation is essential for billing C055 successfully.
- Copy of the written consultation request in medical records.
- Request must include the consultant's name or specialty, referrer's details, and patient identification.
- Written report with findings, opinions, and recommendations submitted to the referring party.
5Weak vs. Strong Note Examples
The strong note succeeds due to its specificity in documenting the referring consultant's information, patient details, and the comprehensive nature of the assessment and report, fulfilling eligibility requirements. The weak note lacks essential detail, risking non-compliance.
Seen a patient for consultation. Will send report later.
Consultation requested by Dr. Smith (referrer #123456) for patient John Doe (Health #987654321) regarding potential exposure to infectious agent.
Assessment conducted; evaluated potential impacts on unit.
- Comprehensive findings documented.
- Detailed recommendations provided, report sent on 2023-10-04.
