1What Is the C264 OHIP Code?
Definition
The C264 billing code is designated for medical specific re-assessments provided by pediatricians to in-patients. This service involves evaluating how a child, previously assessed, is responding to initiated treatment plans. Typical scenarios include monitoring a child's progress in feeding or their response to therapeutic interventions before discharge.
Clinical Context
Within pediatrics, re-assessments are crucial for ensuring that in-patient treatments are proceeding as expected. Pediatricians are often required to re-evaluate patients to adjust their care plans, ensuring that children are prepared for discharge. This code is commonly used when there are anticipated changes in a patient's status.
Commonly Missed
This code can be missed when time records are not diligently maintained. Physicians often overlook capturing precise start and end times for the re-assessment, which is required for billing eligibility.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A263 | Medical specific assessment | Governed by specialty listing rules | Initial assessment for pediatric patients in various settings, worth $95.75. |
| C263 | Medical specific assessment | Governed by specialty listing rules | In-patient initial assessment for pediatric patients, worth $95.75. |
| A264 | Medical specific re-assessment | Equivalent to C264 for out-patient settings, governed by specialty listing rules | Re-assessment for pediatric patients in out-patient settings, worth $70.75. |
| A661 | Complex medical specific re-assessment | Governed by specialty listing rules | More detailed re-assessment in pediatrics for complex cases, worth $86.35. |
3Eligibility Requirements
C264 is eligible for use under the following circumstances:
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Virtual Delivery: C264 can be rendered virtually and billed as C264A, but it must be delivered via video. Telephone consultations do not qualify for this billing code under Comprehensive Virtual Care Services.
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Time Recording: Physicians must record the exact start and end times of the service in the patient's permanent medical record for the service to be payable.
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Assessment Location: This code is applicable for services rendered in a hospital in-patient setting. For equivalent assessments conducted in out-patient settings, use code A264.
4What Your Clinical Note Must Show
To ensure billing compliance, the following items must be documented:
- Start time of the service
- End time of the service
In addition to time, other elements should be documented to justify the re-assessment:
- Reason for re-assessment
- Findings from assessment
- Plan or change in management
5Weak vs. Strong Note Examples
The strong note succeeds because it provides detailed observations and an actionable plan, alongside precise timing. The weak note lacks detailed findings and does not record time, which are critical for compliance.
Reviewed patient's feeding progress.
Plan: Continue with current care.
Conducted a detailed re-assessment of the patient's ongoing feeding issues.
Reviewed current feeding regime effectiveness.
Assessment Method:
- Time: 2:00 PM - 2:30 PM
- Observed patient tolerating current feeding volume with mild discomfort.
- Plan to modify feeding regime by reducing volume and increasing frequency.
- Discussed changes with care team and obtained consent from guardians.
