1What Is the C285 OHIP Code?
Overview of C285 Billing Code
C285 is a billing code under OHIP used specifically for pathology consultations on hospital in-patients. This code enables pathologists to provide expert evaluations on complex or urgent cases such as transfusion reactions, decisions on apheresis, or unexplained laboratory results that require specialized input.
Clinical Context
This code is commonly used in scenarios where hospital in-patients present issues that the primary treating physicians or team cannot resolve alone due to the case's complexity. These consultations are vital for addressing intricate medical queries and ensuring proper patient management.
Commonly Missed Billing Opportunities
Physicians may overlook billing opportunities for C285 due to misunderstandings about the frequency limits or the assumption that virtual consultations do not qualify. Additionally, failing to document the consultation request appropriately can result in reduced payments.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A285 | A285 Consultation | Identical frequency use as C285 | Same service rendered outside hospital in-patient settings. |
| A286 | A286 Limited consultation | As per specific requirements | Used for less complex consultations. |
| A580 | A580 Comprehensive internal medicine consultation | Subject to its specific criteria | Comprehensive consultations for complex internal medicine cases. |
| A585 | A585 Diagnostic consultation | According to diagnostic criteria | Used for diagnostic purposes in laboratory medicine. |
3Eligibility Requirements
Detailed Eligibility Requirements
To bill OHIP under C285, the following conditions must be met:
- Service Setting: Must be rendered in a non-emergency hospital in-patient setting.
- Consultation Request: A written request from a physician, nurse practitioner, or dental surgeon is required. This must be based on the complexity, seriousness, or obscurity of the case.
- Documentation: Keep a copy of the written request signed by the referring professional in your records, unless the consultation occurs in settings with common medical records.
- Frequency Restrictions:
- One service per two consecutive 12-month periods for the same patient, same physician, same diagnosis.
- Two services allowed if the second is in a hospital or emergency setting, rendered more than 12 but less than 24 months after the first.
- One service every 12 months for unrelated diagnoses.
Note: Virtual consultations may only be billed as C285A and are limited to video, not telephone.
4What Your Clinical Note Must Show
Ensure compliance with these documentation requirements:
- Maintain a written referral request in the medical record.
- The request must include consultant and referrer identification details.
- Record must detail the relevant patient information and requested services.
- Document the start and end times of the service rendered.
5Weak vs. Strong Note Examples
The strong note succeeds by including a detailed record of the referral and service specifics, meeting all OHIP documentation requirements, while the weak note lacks necessary details and fails to confirm a written request.
Consultation for transfusion reaction performed. Discussed with team. No written referral on file.
Received written referral from Dr. Smith for patient John Doe (Health #123456).
Consultation performed in response to a complex transfusion reaction. Detailed report prepared and sent to Dr. Smith.
- Referral documentation retained.
- Patient identified accurately with health number.
- Specific service times documented.
