1What Is the C196 OHIP Code?
C196 is an OHIP billing code used by psychiatrists for providing a repeat consultation to a hospital in-patient. This service is essential when a patient's condition demands reassessment due to changes such as emerging psychosis, deterioration in mental health status, or complications from medication.
The repeat consultation is distinct as it requires a new written request from the referring physician or nurse practitioner, differentiating it from a regular follow-up visit. This requirement often leads to billing errors when not adequately documented.
Psychiatrists use C196 to reassess patients who have shown new clinical issues necessitating a repeat evaluation. Proper usage ensures comprehensive patient care and correct compensation for the psychiatrist's expertise.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A190 | Special psychiatric consultation | Subject to frequency rules in GP17 | Higher-level psychiatric evaluation for complex cases. |
| A195 | Consultation | Subject to frequency rules in GP17 | Standard psychiatric consultation. |
| A196 | Repeat consultation | Repeat consultations require a new request each time | For repeat assessments outside of hospital in-patient settings. |
| A395 | Limited consultation | Subject to frequency rules in GP17 | Shorter, focused psychiatric assessment. |
3Eligibility Requirements
Eligibility Requirements
- Setting: C196 must be rendered to a hospital in-patient.
- Request: Each consultation requires a fresh written request from the referring physician, nurse practitioner, or dental surgeon.
- Virtual Delivery: C196 may be billed as C196A if conducted virtually, specifically via video. Consultations done by telephone do not qualify as eligible services under the Comprehensive Virtual Care Services.
- Code Equivalency: The equivalent code for services rendered outside hospital settings is A196.
4What Your Clinical Note Must Show
Ensure all the following documentation is in place before billing C196:
- Written request from referring physician or nurse practitioner.
- Evidence of a clinically relevant change or complication in the patient’s condition.
- Documentation of the consultation findings and treatment plan adjustments.
- Notification to the referring physician of the consultation results.
5Weak vs. Strong Note Examples
The strong note succeeds by clearly referencing the new referral, describing the changes in patient condition, and outlining specific actions taken, which are missing in the weak note.
Patient seen for repeat evaluation. Referral received.
Assessed current symptoms and discussed medications.
Repeat psychiatric consultation performed at the request of Dr. Jones due to patient's new onset of auditory hallucinations.
Clinical assessment focused on the patient's response to the current medication regimen and the need for possible adjustments.
- Written request from Dr. Jones in patient's file.
- Patient's hallucinations under new review.
- Medication plan discussed and modified as necessary.
- Update sent to referring physician by end of the day.
