1What Is the C164 OHIP Code?
What is C164?
C164 is the OHIP billing code used by nephrologists to bill for medical specific re-assessments of hospital in-patients. These re-assessments are typically limited to kidney-related issues, such as monitoring renal function following an adjustment in diuretics or antihypertensive therapy, or reviewing creatinine trends post-contrast studies.
The focus is on a targeted evaluation to address specific renal questions. This code is often overlooked due to its strict eligibility requirements or when the documentation does not fulfill OHIP's detailed criteria.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A163 | Medical specific assessment | As needed | Comprehensive initial assessment for nephrology patients. |
| C163 | Medical specific assessment | As needed | Comprehensive initial assessment for nephrology in-patients. |
| W164 | General re-assessment of patient in nursing home | As needed | General re-assessment under the Nursing Homes Act. |
| A161 | Complex medical specific re-assessment | As needed | Complex re-assessment involving more intricate renal evaluations. |
3Eligibility Requirements
Eligibility Requirements for C164
- Setting: Must be used for non-emergency hospital in-patient services.
- Frequency: Limited to two re-assessments per patient per physician annually, barring hospital admission-related assessments.
- Virtual Care: Can be delivered virtually by video only, not by telephone, and billed as C164A.
- Examination Requirements: Involves a full and relevant history and physical exam pertaining to nephrological systems.
- Time Documentation: Must document the start and end times of the service in the patient's permanent medical record.
Consult the OHIP Schedule of Benefits and associated General Preamble for additional guidance.
4What Your Clinical Note Must Show
Ensure the following elements are recorded in the patient's permanent medical record:
- A full, relevant history and physical examination focused on nephrology concerns.
- Start and end times of the assessment
- Specific renal issue addressed (e.g., creatinine trend, diuretic adjustment).
5Weak vs. Strong Note Examples
The strong note succeeds because it provides detailed history, examination insights, and a clear management plan, while adhering to OHIP documentation standards.
Reviewed patient post-diuretic change. No further issues noted.
Patient re-assessed due to elevated creatinine following contrast study. History taken revealed no new complaints. Physical exam focused on renal and cardiovascular systems, showing stable vitals. Plan: Maintain current antihypertensive regimen, repeat labs in two days.
- Explicit mention of nephrology-focused assessment.
- Clear documentation of history and examination.
- Specific evaluation and follow-up plan outlined.
