C223 OHIP Billing Code: Maximize Your Practice's Reimbursement for Extended Genetic Consultations

The C223 billing code is used to claim reimbursement for extended special genetic consultations in Ontario under OHIP. Targeted specifically for medical genetics and genomics specialists, this code applies to consultations that extend for a minimum of 90 minutes in direct patient contact. It is primarily used in hospital in-patient settings such as assessing newborns or critically ill adults with suspected genetic syndromes.

Commonly missed aspects in billing C223 include failing to meet the minimum contact time, not documenting start and stop times accurately, or submitting claims for services beyond the defined frequency limits. Proper documentation and adherence to eligibility criteria are crucial to ensure reimbursement.

The C223 code is applicable for consultations in which the physician provides all elements of a typical consultation and documents at least 90 minutes of direct patient interaction. The service eligibility mandates:

• One service per two consecutive 12-month periods for the same patient, physician, and diagnosis, unless:
  • The second consultation is for a hospital inpatient or Emergency Department patient more than 12 but less than 24 months after the first.
  • The diagnosis is clearly unrelated, allowing one service every 12 months.
• In instances exceeding these limits, services may only be reimbursed at the general or specific assessment rate.
• Medical records must include the start and stop times of the consultation. Failure to include these details will render the service non-payable.

For virtual services, C223 may be billed as C223A for video consultations, but not for telephone-based interactions.