1What Is the C095 OHIP Code?
C095 is an OHIP billing code used for consultations in cardiac surgery specifically for non-emergency hospital in-patients. Typically, this code applies when a patient admitted with severe coronary or valve disease requires a surgical opinion, often during the same admission as their catheterization.
This code ensures that when a cardiac surgery consultation is needed, the consulting physician can provide a thorough assessment and recommendations in a written report. It is important to bill this code correctly and understand its specific usage within the context of cardiac surgery consultations, ensuring comprehensive care for patients in complex cases.
Consultations may be missed if documentation requirements are not met, or if billing frequency limits and settings are misunderstood. Adhering to guidelines helps maximize reimbursement while improving patient care.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | N/A | A special surgical consultation in the cardiac surgery listings. |
| C935 | Special surgical consultation | N/A | A special surgical consultation in the cardiac surgery listings. |
| A095 | Consultation | One service per patient, per 12 months for the same diagnosis | Equivalent service rendered outside of hospital in-patient settings. |
| A096 | Repeat consultation | As needed when specific requirements for repeat are met | Used when a repeat consultation for the same patient with the same diagnosis is required. |
3Eligibility Requirements
In order to be eligible for billing under C095, the consultation must be provided to a non-emergency hospital in-patient, following a written request from a referring physician, nurse practitioner, or dental surgeon. This request must result from the complexity or seriousness of the case or because another opinion has been requested.
Key points include:
- A written request for the consultation, signed by the referring party, needs to be maintained in the consulting physician's records unless in common record settings.
- This request should identify the referring and consulting physicians by name and billing number, and provide relevant information on the requested service.
- It must be clear that the consultation is for a cardiac surgery patient referred during the same hospital admission.
Failure to meet these requirements will result in the service being paid as a lesser assessment fee.
4What Your Clinical Note Must Show
Ensure documentation captures all details as per OHIP requirements.
- Include a copy of the written request signed by the referring party, unless in a common record setting.
- Label documentation with the consultant's name and billing number.
- Include the patient's name and health number in the records.
- Specify the relevant details of the requested consultation.
5Weak vs. Strong Note Examples
The strong note succeeds because it includes all required identifiers, relevant clinical details, and specifies the submission of a comprehensive report, making it suitable for C095 billing.
Consultation requested by Dr. Smith. Discussed patient case. Advised surgery.
Consultation requested by Dr. Jonathan Smith, NP123456. Patient: John Doe, HN: 123456789.
Referred for surgical opinion regarding complex coronary disease post-catheterization.
Thorough assessment conducted. Prepared and submitted a detailed report with findings and recommendations to Dr. Smith.
- Consultation request with complete identifiers included.
- Details relevant to diagnosis and purpose of referral are documented.
- Concluded with a thorough written report submission noted.
