1What Is the C185 OHIP Code?
The C185 billing code is designated for neurology consultations in Ontario under OHIP. It is primarily used for hospital in-patient settings, where a detailed neurological assessment is necessary. Such consultations often involve patients presenting with conditions like new headaches, first seizures, or peripheral nerve issues.
Neurologists conduct these consultations to answer specific neurological questions that do not require a prolonged assessment, differentiating it from the more comprehensive Special Neurology Consultation (C180). Incorrect usage of C185 can occur when a case actually warrants a C180 due to the complexity and time required. Thus, it is crucial to accurately assess each patient's needs before billing.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A180 | A180 Special Neurology Consultation | consultation as clinically required | A more detailed and extended assessment for complex neurology cases. |
| A185 | A185 Consultation | consultation as clinically required | The equivalent code for out-patient neurology consultations. |
| A186 | A186 Repeat Consultation | repeat consultation as clinically required | Used for follow-up consultations for neurology cases. |
| A385 | A385 Limited Consultation | limited consultation as clinically required | Used for brief consultations with less complexity. |
3Eligibility Requirements
C185 can be billed once per patient, per physician, per diagnosis every two consecutive 12-month periods. An exception exists for two services within this timeframe if the second service occurs in a hospital or ER setting more than 12 but less than 24 months after the first.
When a new, unrelated diagnosis is confirmed, C185 may be billed once every 12 months. Virtual delivery of C185 is permissible only via video, not telephone, and should be billed as C185A. Ensure that consultations follow six months after a Periodic Health Visit under the Nursing Homes Act.
4What Your Clinical Note Must Show
Ensure comprehensive documentation of the neurological consultation.
- Patient history and presenting complaint
- Details of neurological examination
- Assessment, diagnosis, and management plan
- Rationale for choosing C185 over other codes
5Weak vs. Strong Note Examples
The strong note provides a comprehensive assessment, considering differential diagnoses and strategies, whereas the weak note lacks depth in evaluation and fails to justify the chosen management plan effectively.
Patient presented with headache. Conducted a quick assessment and advised on pain management. Follow-up if pain persists.
Patient admitted with first-time seizure episodes. Comprehensive neurological exam conducted revealing signs consistent with epilepsy. Discussed management plan including potential AED therapy.
Considered differential diagnoses including migraine and ruled out with detailed history and clinical examination. Scheduled follow-up consultation.
- Comprehensive history and exam findings documented
- Differential diagnoses considered and explored
- Clear patient management and follow-up plan defined
