1What Is the C235 OHIP Code?
What is C235?
C235 is an OHIP billing code used by ophthalmologists for consultations conducted in a non-emergency, hospital in-patient setting. It applies typically when assessing complex ophthalmic cases such as acute visual loss, suspected endogenous endophthalmitis, or ocular involvement in systemic diseases.
This code is crucial for ensuring proper compensation for comprehensive ophthalmic evaluations where in-depth analysis and expertise are needed. It’s important for physicians to accurately document these consultations to meet OHIP’s billing requirements.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | As per Ophthalmology listings | Advanced surgical consultations under Ophthalmology. |
| C935 | Special surgical consultation | As per Ophthalmology listings | Advanced surgical consultations for inpatients. |
| A231 | Neuro-ophthalmology consultation | As per Ophthalmology listings | Consultation that involves neurological consideration of ocular issues. |
| A235 | Consultation | Equivalent outpatient service | Consultation services rendered outside hospital in-patient settings. |
3Eligibility Requirements
C235 Eligibility Requirements
- Setting: C235 is used for consultations in non-emergency hospital in-patient services.
- Request Documentation: A written request from a referring physician, nurse practitioner, or dental surgeon is mandatory. It must identify the consultant and the referring entity by name and include the patient’s details and OHIP health number.
- Frequency: One consultation per two consecutive 12-month periods per patient, per diagnosis. A second service can be billed if the consultation is for a hospital inpatient or patient in an Emergency Department, rendered more than 12 but less than 24 months after the first.
- Unrelated Diagnosis: When clearly defined and unrelated, one service may be billed per 12-month period.
Failure to meet these conditions may result in reduced compensation.
4What Your Clinical Note Must Show
Ensure these items are included in the medical record to support billing C235.
- Written request for consultation with consultant, referring physician, NP, or dental surgeon’s details.
- Patient’s full name and OHIP health number.
- The specific services requested and relevant clinical information.
- A copy of the written consultation report furnished to the referring party.
- Times when the service started and ended recorded on the patient's chart.
5Weak vs. Strong Note Examples
The strong note succeeds by providing specific details including the referrer's name, patient's name and health number, explicit reason for referral, examination details, recorded duration, and confirmation of a written report. The weak note lacks these critical details.
Referred by Dr. Smith for examination. Exam conducted; assessment notes to follow.
Consultation requested by Dr. John Doe at Hospital X.
Patient: Jane Doe, OHIP#: 1234567890.
Purpose: Suspected endophthalmitis following surgery — detailed assessment and written recommendations needed.
Consultation included complete ocular examination and B-scan ultrasound.
- Time: Service began at 2:00 PM and concluded at 2:45 PM.
- Report: A full consultation report was sent back to Dr. John Doe.
