1What Is the C096 OHIP Code?
The C096 billing code applies to repeat consultations for cardiac surgery within non-emergency hospital inpatient settings. This code is used when a cardiac surgeon conducts an additional consultation for the same presenting problem after another physician has provided interim care. It's crucial for these consultations to have a new written referral from a referring physician, nurse practitioner, or dental surgeon.
This consultation is specific to scenarios in cardiac surgery where ongoing patient conditions warrant re-evaluation. For instance, a patient initially referred for potential cardiac surgery may need a reassessment based on their response to treatments like antibiotic therapy for endocarditis. This code ensures continuity of expert care while meeting specific billing requirements.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | A comprehensive surgical consultation for complex or special cases. | |
| C935 | Special surgical consultation | Similar to A935, but may apply to different specifics in the cardiac surgery listings. | |
| A095 | Consultation | Standard consultation code for cardiac surgery. | |
| A096 | Repeat consultation | Equivalent repeat consultation code applicable in out-patient settings. |
3Eligibility Requirements
To bill for C096, ensure compliance with these requirements:
- Patient Setting: Must be rendered in a non-emergency hospital inpatient setting.
- Written Request: A new written request from a referring physician, nurse practitioner, or dental surgeon is mandatory. The request must be documented in the consultant's medical records unless it's a facility with shared medical records.
- Interval Care: The repeat consultation occurs after care has been rendered by another physician since the initial consultation.
- Consultation Type: This code is exempt from the frequency limits that apply to initial consultations.
- Virtual Care: Can only be billed if the consultation is conducted via video, not by telephone.
4What Your Clinical Note Must Show
Ensure these documentation requirements are fulfilled to bill C096 effectively:
- Maintain a copy of the written request for the repeat consultation, signed by the referring party.
- Associate the consultation notes with the correct clinical context for re-referral.
- Verify the consultation occurs after prior intervention by another physician.
5Weak vs. Strong Note Examples
The strong note succeeds because it clearly establishes the clinical need for reevaluation, includes pertinent details about treatment progress, and identifies the referral source and reason.
Patient referred for repeat consultation. No other details provided.
Conducted a repeat consultation for patient diagnosed with bacterial endocarditis. Originally referred on [date] and treated with antibiotics. Referring physician [name] requested re-evaluation due to incomplete response before deciding on surgical intervention.
- Includes specific diagnosis (bacterial endocarditis).
- Documents treatment progress (antibiotics).
- Notes referral information and purpose.
