1What Is the C113 OHIP Code?
C113 is an OHIP billing code used for complex neurological assessments conducted on hospital in-patients. These assessments are integral for managing patients with established chronic complex neurological diseases, such as advanced multiple sclerosis, ALS, or refractory epilepsy, where ongoing specialized neurologist involvement is required.
C113 ensures that neurologists are reimbursed for the additional time and expertise needed in these scenarios, distinguishing itself from simpler evaluations by focusing on comprehensive management needs. This code should not be used for initial evaluations or uncomplicated conditions like carpal tunnel syndrome.
Commonly missed points include the fact that the assessment is not eligible for initial evaluations, the patient's chronic complex diagnosis must be documented, and services are capped at 6 per patient per physician annually. Additionally, start and stop times must be meticulously recorded.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A113 | Complex neurological assessment | Same conditions as C113 | Equivalent service outside hospital settings. |
| A180 | Special neurology consultation | As required | A comprehensive consultation regarding complex neurological issues. |
| A185 | Consultation | As required | General neurological consultation services. |
| A186 | Repeat consultation | As required | Follow-up consultations after initial assessment. |
3Eligibility Requirements
To bill OHIP C113, the following eligibility criteria apply:
- Service Scope: Must include elements of a medical-specific re-assessment.
- Initial Evaluation Exclusion: The service is not eligible for the initial evaluation of a patient by the billing physician.
- Frequency Limits: Limited to 6 assessments per patient, per physician, per 12-month period. Exceeding this limit results in fee adjustments to a lesser assessment fee.
- Pre-existing Diagnosis: The patient must have an established diagnosis of a chronic complex neurological disease.
- Incompatible Service Codes: E078 cannot be billed in conjunction with this code.
The service requires thorough documentation of start and stop times in the patient’s medical record for full payment.
4What Your Clinical Note Must Show
Ensure all elements of service provision are recorded to meet OHIP's requirements.
- Record the start and stop times of the assessment.
- Document the pre-existing chronic complex neurological diagnosis.
- Detail all re-assessment elements conducted during the service.
5Weak vs. Strong Note Examples
The strong note succeeds by providing comprehensive documentation that includes specific elements of the reassessment and records required details. The weak note fails due to general language and missing required documentation like start and stop times.
Patient seen in follow-up. Assessment done.
Patient with advanced multiple sclerosis presented for ongoing management.
Performed a detailed neurological re-assessment covering motor function, balance, and cognitive status.
- Start time: 13:00
- Stop time: 13:45
- Diagnosis discussed: ALS
- Management plan updated.
