1What Is the C056 OHIP Code?
What is C056?
C056 is a billing code under the Ontario Health Insurance Plan (OHIP) used by Preventive Medicine specialists to charge for repeat consultations in a hospital in-patient setting. These consultations involve revisiting a patient for the same health issue after a new referral from another healthcare provider.
In clinical practice, this often involves consultation on new public health concerns or re-evaluation of preventive measures needed for a patient, such as changes in control measures or new exposure questions. Physicians commonly overlook this billing code when the consultation appears as a routine reassessment rather than a distinct repeat consultation.
The key to correctly applying C056 is ensuring a new written request from the referring provider, which sets this service apart from follow-up assessments.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A050 | Special community medicine consultation | N/A | Used for comprehensive initial consultations in community medicine, offering detailed assessments. |
| A055 | Consultation | N/A | Default code for initial consultations in community medicine without the need for significant comprehensive review. |
| A056 | Repeat consultation | N/A | For out-patient repeat consultations, providing parity for in-patient C056 services. |
| A400 | Comprehensive community medicine consultation | N/A | Involves thorough evaluation in community medicine for complex case management. |
3Eligibility Requirements
Eligibility Requirements for C056
C056 applies exclusively to non-emergency hospital in-patient services. It allows for repeat consultations when a new written request is made by the referring physician, nurse practitioner, or dental surgeon. The key eligibility points include:
- Setting: Must occur in a hospital in-patient setting.
- Request: A documented new written request from the referring provider is mandatory and must be kept in the consultant's medical record, except in integrated records environments like hospitals.
- Consultation Context: Must follow care by another physician for the same issue, but involve a new clinical question or change in the intervention requirement.
Failure to meet these criteria results in payment adjustment to a lesser assessment fee.
4What Your Clinical Note Must Show
Ensure the following documents are part of the medical record:
- New written consultation request by a referring healthcare professional.
- Maintain a copy of the request in the patient's medical record.
- Ensure compliance with common medical record standards in integrated settings.
5Weak vs. Strong Note Examples
The strong note includes clear documentation of a new referral, the clinical reasoning for the repeat consultation, and specific actions taken, providing a comprehensive picture of medical decision-making.
Patient seen again after initial consultation, no changes noted.
Repeat consultation conducted after new referral due to changes in patient's exposure risk requiring reassessment.
Updated intervention plan included additional control measures following reviewed exposure risk.
- Documented new referral source.
- Clear clinical rationale for repeated assessment.
