1What Is the C175 OHIP Code?
C175 is an OHIP billing code specific to vascular surgery consultations provided to non-emergency hospital in-patients. This service is crucial when the medical or emergency team seeks the vascular surgeon’s expertise on severe conditions such as acutely ischaemic limbs, symptomatic aneurysms, or access for dialysis in an admitted patient.
The consultation must follow a written request from a qualified referring professional, and the aim is to provide a comprehensive evaluation, culminating in a detailed written report with findings and recommendations. Due to its complexity and significance, ensuring that all documentation and eligibility criteria are met is essential to avoid non-payment.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | As needed within service requirements | Higher fee consultation for cases with additional complexities in vascular surgery. |
| C935 | Special surgical consultation | As needed within service requirements | Similar to A935, specific for hospital settings. |
| A175 | Consultation | One service per two consecutive 12-month periods | Non-hospital in-patient equivalent of C175. |
| A176 | Repeat consultation | As required after the initial consultation | Used when a repeat consultation is necessary under different circumstances. |
3Eligibility Requirements
Eligibility for billing C175 encompasses several strict criteria:
- Setting: The service is only rendered to non-emergency hospital in-patients.
- Frequency: One service per two consecutive 12-month periods unless the second consultation is for a hospital inpatient or an emergency department patient more than 12 but less than 24 months after the first. Unrelated diagnosis allows for one service every 12 months.
- Consultation Requirements: Must be a written request from a referring physician, nurse practitioner, or dental surgeon. The consultation should culminate in a written report.
- Virtual Services: C175 may be billed for virtual consultations via video (but not by telephone) using the code C175A.
Failure to meet these requirements may lead to reduced payment at the rate of a general or specific assessment fee.
4What Your Clinical Note Must Show
Maintain comprehensive records to ensure compliance and facilitate billing under C175.
- A written consultation request from a referring physician, NP, or dental surgeon.
- The consultant’s written report including findings, opinions, and recommendations.
- Documentation of the consultation time - start and end times must be recorded.
- Copies of all relevant documents kept in the patient's medical record.
5Weak vs. Strong Note Examples
The strong note succeeds because it includes comprehensive information, precise timing, and clinical recommendations, unlike the weak note which lacks detail.
Consultation performed on 10/03/2023. Patient referred by GP. Recommended review in clinic.
Consultation performed on 10/03/2023. Patient referred by Dr. Smith (Billing #: 123456) for acute ischaemia of the left leg. Consultation began at 10:00 AM and concluded at 11:30 AM.
Findings: Severe occlusion detected in the popliteal artery.
Recommendations: Surgical intervention required within 48 hours. Detailed report sent to referring physician.
- Ensure the note reflects a complete, detailed account.
- Specify referral source, dates, and comprehensive clinical findings.
