1What Is the C194 OHIP Code?
What is the C194 Billing Code?
C194 is an OHIP billing code for specific re-assessments conducted by psychiatrists for in-patients. This re-assessment is a follow-up to a prior consultation or assessment and is utilized to monitor a patient's response to treatment, assess risks, or determine discharge readiness.
In the psychiatric context, this re-assessment is critical for evaluating medication effects, reassessing the patient's condition post-delirium, or determining the patient's risk before discharge or temporary leave. The code ensures that the ongoing evaluation of psychiatric in-patients is recognized and funded appropriately.
Despite its importance, this code can be missed if the primary assessment documentation does not justify the necessity for a repeated detailed examination or if the documentation does not meet OHIP's requirements.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A193 | Specific assessment | N/A | Conducted to establish a diagnosis or evaluate a complex case. |
| C193 | Specific assessment | N/A | Used for in-patient settings similar to A193 but coded specifically for hospital use. |
| A194 | Partial assessment | N/A | Covers a less comprehensive follow-up examination, usually outpatient. |
| A190 | Special psychiatric consultation | N/A | Reserved for intricate, resource-intensive consultations or second opinions. |
3Eligibility Requirements
Eligibility for Billing C194
According to the OHIP Schedule of Benefits, the C194 re-assessment must comply with the following:
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Virtual Delivery: The re-assessment can be conducted virtually through video only, billed as C194A. Telephone delivery does not qualify as a Comprehensive Virtual Care Service.
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General Assessment Requirements: Align with the General Preamble GP21, which mandates a comprehensive history and examination, excluding invasive exams if not appropriate.
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Time Recording Compliance: The start and end times of the assessment must be accurately documented in the patient's medical record (General Preamble GP7.f).
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Out-Patient Equivalent: The corresponding service outside in-patient settings uses code A194.
4What Your Clinical Note Must Show
Ensure start and end times are recorded in the patient's permanent medical chart.
- Record the exact time the service began and ended in the medical records.
Documentation must reflect a full history and examination as guided by General Preamble GP21.
- History of presenting complaint
- Family medical history
- Past medical history
- Social history
- Functional inquiry
- Physical examination documentation, if applicable
5Weak vs. Strong Note Examples
The strong note provides detailed observations and a complete history, while the weak note lacks necessary detail and clear documentation of examination findings.
Reviewed patient's medications. Adjustments were made.
Re-assessment conducted to evaluate the patient's response to new antipsychotic medication.
History taken included patient's symptom evolution since last assessment, medication adherence, and side effects.
Physical examination included mental status evaluation, no further physical signs noted.
- Response to medication stabilized
- No side effects reported
- Plans for next assessment discussed with patient
