C275 OHIP Billing Code: Limited Consultation

1What Is the C275 OHIP Code?

Understanding C275

The C275 billing code is used for limited consultations in the Infectious Disease specialty within non-emergency hospital in-patient settings. It is designed for situations that require a specific, concise opinion from an infectious disease expert. Typical scenarios include providing recommendations on antibiotic selection or the duration of treatment, or decisions about patient isolation.

The service is considered 'limited' as it demands less time and effort compared to comprehensive consultations, allowing physicians to provide an essential, targeted insight without a full diagnostic work-up. Due to its focused nature, it may often be overlooked when physicians engage in brief, yet crucial, patient evaluations.

2Related Codes

Code	Name	Frequency	Description
A275	Limited consultation	Similar eligibility	For out-patient settings equivalent to in-patient limited consultation.
A460	Comprehensive infectious disease consultation	Subject to OHIP consultation frequency limits	For full assessments needing comprehensive specialist input.
A465	Consultation	Subject to OHIP consultation frequency limits	Standard consultation code within Infectious Disease specialty.
A466	Repeat consultation	As required for repeat consultations	Used when re-evaluating a patient post initial consultation.

3Eligibility Requirements

Eligibility Criteria

To bill OHIP using the C275 code, the following criteria must be met:

Setting: Must be rendered in non-emergency hospital in-patient settings for infectious disease cases.
Request Source: A request must come from a referring physician, nurse practitioner, or dental surgeon related to an insured dental procedure, requiring the infectious disease physician's expertise.
Consultation Parameters: Eligible for video virtual delivery but not by telephone. Documented start and stop times in the patient's permanent medical record are mandatory.

These must align with the general preamble consultation requirements stated under GP16, ensuring the case complexity necessitates specialist advice.

4What Your Clinical Note Must Show

1Mandatory Documentation

For the C275 code to be validated, ensure that accurate medical records are maintained.

Record precise start and stop times of the consultation.
Records must reflect the limited nature of consultation - focusing on specific advice.
Maintain documentation to justify consultation necessity due to case complexity.

5Weak vs. Strong Note Examples

The strong note succeeds by providing detailed clinical actions and recommendations with documented timing, justifying the limited consultation. The weak note lacks specific clinical engagements and documented times.

❌ Weak Note

Consulted for infectious disease management. Suggestions provided.

✓ Strong Note

Consult request from ward team for antimicrobial management.

Examined patient with recurrent fever post-op.

Recommendation to initiate vancomycin 1g every 12h and isolate due to MRSA.

Start Time: 10:00, End Time: 10:20
Focused on antimicrobial choice and isolation need.

6Common Reasons This Code Is Missed

Unrecorded Time

Failing to log start and end times will result in a billing downgrade.

Improper Setting Use

Applying code outside non-emergency in-patient settings results in a denial.

Virtual Provisions Misuse

Billing for telephone consults instead of video can lead to adjustments.

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8Frequently Asked Questions

What is the fee for C275 under OHIP?

The fee for C275 under OHIP is CAD 119.30, billed for limited infectious disease consultations.

How frequently can C275 be billed for the same patient?

C275 can be billed once per two consecutive 12-month periods for the same diagnosis from the same physician.

Which situations in infectious disease require a limited consultation?

Limited consultations are often required for quick recommendations on antimicrobial choice or isolation decisions.

What conditions typically justify a limited consultation over a comprehensive one?

Less complex scenarios such as evaluating the necessity of isolation or immediate antibiotic choices may warrant a limited consultation.

Can repeat consultations be billed during the same referral period?

Repeat consultations (A466) can be billed if additional reviews are necessary within the allowed frequency criteria.

What steps should be taken if a patient is referred by a GP for an infectious disease consultation?

Verify the referral's complexity warrants a specialist consultation and document the consultation's targeted nature.

How is billing handled if the consultation occurs virtually?

Billing for virtual consultations is valid only if done via video, not telephone, and should be billed as C275A.

When a hospital ward consults for an opinion on post-operative infection control, can C275 be applied?

Yes, if the consult purpose is specific advice on such matters, C275 is applicable when criteria are met.

Disclaimer: This article is intended as a general educational resource for physicians and billing staff. It does not constitute billing advice or a definitive interpretation of the OHIP Schedule of Benefits. Always verify current billing codes, eligibility criteria, and documentation requirements directly against the official Schedule of Benefits or consult with a qualified medical billing specialist.

C275 OHIP Billing Code: Optimize In-Patient Infectious Disease Consultations

1What Is the C275 OHIP Code?

Understanding C275

2Related Codes

3Eligibility Requirements

Eligibility Criteria

4What Your Clinical Note Must Show

5Weak vs. Strong Note Examples

6Common Reasons This Code Is Missed

8Frequently Asked Questions