1What Is the C220 OHIP Code?
The C220 OHIP billing code pertains to special genetic consultations conducted by physicians in the field of Medical Genetics and Genomics. These consultations are extensive, requiring a minimum of 75 minutes of direct contact with the patient, whether with the involvement of their family or not. This code is applied typically in non-emergency hospital in-patient settings.
Genetic consultations under C220 are pivotal in scenarios such as evaluating suspected inherited disorders in adults, or neonates presenting with dysmorphic features. It requires the genetic specialist to perform a thorough assessment and provide a detailed report back to the referring healthcare professional.
Billing for C220 may sometimes be overlooked due to the strict requirement for minimum contact time and comprehensive documentation, including precise start and stop times in the patient record.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A220 | Special genetic consultation | Same restrictions as C220 | Used for similar services outside hospital in-patient settings. |
| A223 | Extended special genetic consultation | More comprehensive cases | Suitable for cases requiring more than the time typical for C220. |
| A225 | Consultation | General use | For standard consultation services in Genetics. |
| A226 | Repeat consultation | Following a previous consultation | When a subsequent assessment of the same condition is necessary. |
3Eligibility Requirements
Eligibility Requirements for C220
- Type of Service: Special genetic consultation involving prolonged direct patient contact.
- Time Requirement: Minimum 75 minutes of direct contact, exclusive of any other separately billable interventions.
- Patient Setting: Typically for in-patients in non-emergency hospital settings.
- Frequency Limits:
- One service per patient every two consecutive 12-month periods for the same diagnosis.
- Exceptions allow two services if the second service is for in-patient or Emergency Department care, performed 12 to 24 months after the first.
- Separate diagnoses may allow for one service every 12 months.
- Medical Record Requirements: Start and stop times must be recorded in the patient's permanent medical record.
4What Your Clinical Note Must Show
All consultation times must be accurately documented.
- Record the start and stop times in the patient's permanent medical record.
- Ensure patient-facing time meets the minimum of 75 minutes.
5Weak vs. Strong Note Examples
The strong note includes specific times, detailed interactions, and comprehensive documentation, thereby meeting OHIP billing requirements, unlike the vague weak note.
Consultation for suspected genetic syndrome. An assessment was conducted and findings are noted.
Conducted a special genetic consultation upon referral for a neonate with dysmorphic features. Comprehensive discussion with family included a 78-minute evaluation. Detailed findings below.
- Referral from Dr. Smith received and acknowledged.
- Start time: 10:00 AM, Stop time: 11:18 AM.
- Patient and family discussions included genetic risks, testing, and follow-up care.
