1What Is the C155 OHIP Code?
C155 is an OHIP billing code designated for consultations provided by endocrinologists to hospital in-patients. This consultation typically involves evaluating complex metabolic or endocrinological conditions requiring specialist knowledge. Common scenarios include in-patient glycaemic management, hyponatraemia, hypercalcaemia, and managing steroid use during hospital admissions.
Consultations must follow a written request from a referring physician, nurse practitioner, or dental surgeon, emphasizing the need for an expert opinion. It encompasses a thorough assessment and culminates in a detailed report shared with the referrer. This billing code is crucial in the efficient management of intricate endocrine disorders, ensuring specialists are remunerated for their expert evaluations. Despite its importance, practitioners may miss billing due to oversight of eligibility criteria or documentation requirements.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A150 | Comprehensive endocrinology consultation | Service per distinct patient and case needs | Covers a broader assessment for more complex endocrinology cases. |
| A155 | Consultation | Flexible with equivalent settings for out-patient | Equivalent service for non-in-patient consultations. |
| A156 | Repeat consultation | As needed for ongoing case engagement | For additional insight or follow-up within the same care period. |
| A255 | Limited consultation | Specific cases requiring limited review | Reserved for more straightforward endocrinology consults. |
3Eligibility Requirements
To bill with code C155, adhere to these eligibility requirements:
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Referral Requirements: The service must be requested in writing by a referring physician, nurse practitioner, or dental surgeon due to case complexity or for a second opinion.
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Documentation: Retain a copy of the written referral within the consultant's medical records, detailing the referring health professional’s name, billing number, and the patient’s name and health number.
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Hospital Consultations: Specifically for endo-inpatient settings and may be rendered virtually as C155A via video only.
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Frequency: One consultation per two consecutive 12-month periods for the same patient and diagnosis, with exceptions allowing a second service under specific conditions as outlined in the service description.
A failure to meet these conditions may result in the service being reimbursed at a lower assessment fee.
4What Your Clinical Note Must Show
Ensure the written request is present in the patient’s medical record.
- Include the referring physician, nurse practitioner, or dental surgeon's name and billing number.
- Clearly state the need for consultation due to complexity or second opinion.
Prepare a complete consultation report to send back to the referrer.
- Include findings, opinions, and recommendations.
- The report should address the specific issues raised in the referral.
Record precise start and end times for the consultation in the patient's record.
5Weak vs. Strong Note Examples
The strong note provides a detailed consultation context, referring physician information, and specific recommendations, while the weak note lacks comprehensive assessment details and lacks a follow-up plan.
Consulted on patient's hypercalcaemia.
Advised to monitor levels.
Consultation requested by Dr. Smith to address patient's complex hypercalcaemia.
In-depth assessment conducted on current management and calcium levels.
- Recommended adjusting steroid therapy.
- Provided detailed report to Dr. Smith with specific next steps and follow-up plan.
