1What Is the C231 OHIP Code?
Definition
The C231 billing code is used for neuro-ophthalmology consultations performed by ophthalmologists in a hospital setting. This involves a detailed examination of specific neuro-ophthalmological disorders based on a referral from another healthcare professional.
Clinical Context
Physicians may use this code when evaluating hospital in-patients presenting with sudden visual loss, diplopia, papilloedema, or cranial nerve palsies, typically at the request of a neurology, neurosurgery, or medical team. This specialized consultation ensures proper diagnosis and management of complex eye conditions that involve neurological considerations.
Commonly Missed Opportunities
Underutilization of C231 often occurs due to lack of awareness about specific documentation requirements or eligibility criteria, which include the necessity for fellowship training in Neuro-ophthalmology and documentation of specific exam elements.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | Varies | Billed for complex surgical consultations. |
| C935 | Special surgical consultation | Varies | Billed for complex surgical consultations in a hospital setting. |
| A231 | Neuro-ophthalmology consultation | Varies | Out-patient neuro-ophthalmology consultation. |
| A235 | Consultation | Varies | Ophthalmology consultation for less complex cases. |
3Eligibility Requirements
Eligibility Requirements
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General Requirements: C231 is billed only once per patient for the same condition every two consecutive 12-month periods. However, a second consultation within this period is possible if it involves a hospital inpatient or an Emergency Department visit, and occurs more than twelve but less than 24 months after the first.
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Documented Examination Components: At least four of the following must be documented:
- Detailed pupillary examination
- Detailed extraocular motility examination
- Ocular alignment testing
- Partial or complete neurological examination
- Detailed examination of the fundus
- Analysis of formal visual field test(s)
- Analysis of pertinent diagnostic imaging studies
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Eligible Providers: Only ophthalmologists with fellowship training in Neuro-ophthalmology are eligible to bill C231.
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Patient Conditions: The patient must have a neuro-ophthalmological disorder that justifies the consultation.
4What Your Clinical Note Must Show
To bill for C231, ensure the following are recorded:
- Time documented service started and ended.
- Written request from referring physician, nurse practitioner, or dental surgeon.
- Consultation report with findings, opinions, and recommendations.
- Patient name and health number, referring practitioner details.
5Weak vs. Strong Note Examples
The strong note is effective as it captures detailed examination elements, adheres to documentation rules, and verifies the exact duration of service — elements missing from the weak note.
Patient seen for neuro-ophthalmology issues. Referral from Dr. Smith.
Assessment completed, but documentation lacks specifics on examination components and time spent.
Patient referred by Dr. Smith for acute diplopia. Neuro-ophthalmological consultation involved:
- Detailed pupillary examination and ocular alignment testing
- Neurological examination and fundus examination.
- Analysis of visual field tests
Consultation started at 10:15 AM and ended at 11:00 AM. Comprehensive report sent to Dr. Smith.
- Includes start and end time.
- Details all required examination elements.
- Compiles a comprehensive report to the referring physician.
