1What Is the C205 OHIP Code?
What is C205?
Billing code C205 applies to consultations performed by an obstetrician-gynaecologist for hospital in-patients. These consultations often involve complex cases such as antepartum bleeding, hyperemesis, suspected ectopic pregnancies, or complications discovered during admissions for other reasons. The primary goal is to provide expert opinions and develop management plans for admitted patients.
It is critical to note that cervical cancer screening specimen collection is included in the consultation fee when the pelvic examination is part of the service. This inclusivity is frequently overlooked, leading to billing errors.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | Per event | Higher complexity consultations for surgical opinions. |
| C935 | Special surgical consultation | Per event | Applicable for in-patient settings involving surgical consultations. |
| A205 | Consultation | Same as C205 | Equivalent to C205 for outpatient settings. |
| A206 | Repeat consultation | Per separate event | Follow-up consultations after initial assessments. |
3Eligibility Requirements
Eligibility Requirements
For billing code C205 to be applicable:
- The consultation must be provided by an obstetrician-gynaecologist to a hospital in-patient.
- It is limited to one service per two consecutive 12-month periods for the same diagnosis, patient, and physician. A second service may be rendered within this period if performed for a hospital inpatient or emergency department patient between 12 to 24 months after the first.
- A differently diagnosed consultation can be billed once every 12 months.
- Services exceeding this frequency are compensated at assessment rates, not consultation rates.
- Virtual consultations under C205 can only be billed as video-only encounters.
- Collections of cervical cancer specimens during the consultation in hospital settings cannot be billed with additional codes like E430 or E431.
4What Your Clinical Note Must Show
Inclusions such as cervical cancer screenings are automatically covered in code C205 when performed during a routine pelvic exam.
- Ensure pelvic examination documentation is detailed.
- Note that E430/E431 add-ons are not applicable in hospital settings.
5Weak vs. Strong Note Examples
The strong note is successful due to its comprehensive details, providing a full account of the consultation, while the weak note lacks specificity and essential details.
Patient seen as inpatient for antepartum bleeding. Consult provided.
Patient, 30 y/o female with antepartum bleeding. Detailed consultation performed, including physical examination, history review, and coordination with primary care team for management plan.
Pelvic exam conducted, cervical cancer screening specimen included per hospital routine.
- Complete medical history documented.
- Clear recommendations outlined.
