1What Is the C245 OHIP Code?
What is C245?
The OHIP billing code C245 is designated for consultations conducted by ENT (ear, nose, and throat) specialists for hospital in-patients. These consultations are crucial when evaluating complex conditions like epistaxis, unresolved airway concerns, deep neck space infections, or sudden hearing loss. ENT consultations can determine whether surgical interventions are necessary during a patient's admission.
In the busy environment of a hospital, this code might be missed if attentiveness to its specific criteria is not maintained, especially differentiating between necessary and standard assessments.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | per condition | Consultation for complex surgical evaluation in otolaryngology. |
| C935 | Special surgical consultation | per condition | Surgical consultation for in-patient examination. |
| A245 | Consultation | per two consecutive 12-month periods | Out-patient equivalent of C245. |
| A246 | Repeat consultation | once within the same year | Follow-up consultation in otolaryngology post initial evaluation. |
3Eligibility Requirements
Eligibility Requirements
C245 is eligible for billing when an ENT specialist provides a consultation to a hospital in-patient. According to OHIP guidelines, C245 may be billed once per patient per two consecutive 12-month periods for the same diagnosis and physician. However, two consultations can be billed during this timeframe if the second consultation occurs in a hospital setting more than 12 but less than 24 months after the initial consultation. If the consultation involves a clearly unrelated diagnosis, billing is permissible once every 12 months.
Virtual Delivery: C245 can be billed as C245A when rendered via video consultation, consistent with eligibility conditions for virtual care services. Telephone consultations are not eligible under C245.
4What Your Clinical Note Must Show
Ensure the following documentation is complete before submitting a claim for C245:
- Patient name and ID
- Date and time of consultation
- Detailed reason for consultation
- Assessment findings
- Consultation outcome and plan
- Hospital in-patient status confirmation
- Video consultation platform (if applicable)
5Weak vs. Strong Note Examples
The strong note succeeds because it provides comprehensive documentation, detailing the consultation's purpose, findings, and subsequent plan, whereas the weak note is vague and lacks specific details.
Patient seen for evaluation. Findings discussed. No additional details recorded.
Patient referred by internal medicine for sustained epistaxis unresponsive to initial treatment. Conducted nasal endoscopy revealing active bleed from superior turbinate. Recommended immediate embolization. Consultation provided to ward physician, discussed potential next steps, and outlined post-procedure care. Patient improvement and monitored for any surgical intervention requirement.
- Clear patient details
- Consultation details matching criteria
- Outcome and follow-up steps outlined
