1What Is the C260 OHIP Code?
C260 is an OHIP billing code for special paediatric consultations provided to hospitalized children. It's used for cases that span across multiple medical systems or for complex diagnostic puzzles. For instance, you might render this service for a medically complex child whose discharge plan requires comprehensive evaluation, or for newborns and infants with evolving syndromes under genetic or metabolic evaluation. This code is frequently confused with its office/clinic equivalent, A260, and it's essential to remember the one-per-patient-per-year limit under the same physician to avoid billing errors.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A260 | Special paediatric consultation | once per 12 months | Equivalent for out-patient settings. |
| A265 | Consultation | As needed | Standard consultation in Paediatrics (26) listings. |
| A266 | Repeat consultation | As needed | Follow-up consultations in Paediatrics. |
| A565 | Limited consultation | As needed | Brief consultations in Paediatrics. |
3Eligibility Requirements
Eligibility for C260
- Service Setting: C260 is billed for special paediatric consultations rendered exclusively to hospital in-patients.
- Frequency: This service is limited to one per patient, per physician, every 12 months.
- Virtual Care Eligibility: C260 can be delivered virtually but only via video; it is not billable for telephone consultations.
- Medical Record Requirement: To qualify for full payment, the service's start and stop times must be recorded in the patient's permanent medical record. Failing to include these will result in a reduced fee.
4What Your Clinical Note Must Show
Ensure completeness and compliance.
- Record the start and stop times of the consultation in the patient's permanent medical record.
- Ensure all relevant clinical details are documented thoroughly.
- Include the reason for the consultation and any findings or recommendations.
5Weak vs. Strong Note Examples
The strong note succeeds by including comprehensive clinical details and a clear discharge plan, ensuring specific documentation required by OHIP. The weak note lacks essential diagnostic and management details, risking reduced payment.
*Consultation performed, details recorded. Start time: 10:00 AM, Stop time: 11:00 AM.*
*Special paediatric consultation performed on in-patient.*
*Start time: 10:00 AM, Stop time: 11:00 AM.*
Comprehensive review of multisystem issues including respiratory, and metabolic concerns. Developed coordinated discharge plan in collaboration with multidisciplinary team.
- Detailed case review noted with specific clinical issues.
- Interventions and plan moving forward were clearly documented.
