1What Is the C286 OHIP Code?
What is C286?
C286 is an OHIP billing code for a limited consultation in the context of inpatient laboratory medicine. It is typically used by pathologists to provide succinct, focused advice on specific issues such as transfusion or specimen-handling decisions. Unlike a full consultation, a limited consultation is less demanding in terms of time and complexity.
This code is particularly relevant when a pathologist's expertise is required for short, direct consultations that support the ward team's decision-making. Timely and precise, these consultations are vital in ensuring the delivery of efficient patient care without the extensive scope of a comprehensive assessment. However, the targeted nature of this service means it may sometimes be overlooked when full assessments are documented more prominently.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A285 | Consultation | One service per two consecutive 12-month periods | Full consultation code for comprehensive laboratory medicine assessments. |
| A286 | Limited consultation | Same as C286, but for outpatient settings | Limited consultation delivered outside hospital inpatient settings. |
| A580 | Comprehensive internal medicine consultation | One service per two consecutive 12-month periods | Extended scope consultation involving thorough internal medicine assessments. |
| A585 | Diagnostic consultation | One service per two consecutive 12-month periods | Consultation aimed at diagnosing complex or obscure cases in laboratory medicine. |
3Eligibility Requirements
Eligibility Requirements
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Setting: C286 services must be rendered as non-emergency hospital inpatient services related to laboratory medicine.
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Consultation Requirements: The service must follow a written request from a referring physician, nurse practitioner, or dental surgeon related to an insured dental procedure in a hospital. This request should stem from the complexity, seriousness, or obscurity of the case necessitating a pathologist's expertise.
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Virtual Care: C286 may be delivered virtually but only through video calls; telephone consultations are not eligible under this code.
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Frequency Limits: Billing is restricted to one consultation per two 12-month periods per patient, physician, and diagnosis. Exceptions exist for repeat consultations under specified conditions.
4What Your Clinical Note Must Show
Ensure the following documentation is completed in the patient's medical record to support the use of C286:
- Written consultation request by referring physician, nurse practitioner, or dental surgeon.
- Clearly defined clinical scenario outlining the need for a pathologist's focused opinion.
- Documentation of consultation delivery method—video or in-person for inpatient setting.
- Detailed note on the conclusion or recommendation provided, including any diagnostic reasoning.
5Weak vs. Strong Note Examples
The strong note is effective as it clearly articulates the clinical context, specific patient details, and justifies the consultation's necessity and conclusions. The weak note fails to thoroughly document the clinical scenario and reasoning necessary for audit purposes.
Consulted on specimen handling. Recommend following existing protocol.
Received a request from Dr. Smith regarding transfusion approval for a complex hematology case. Reviewed patient's history and current treatment protocols. Concurred with transfusion plan and suggested further hemoglobin monitoring.
Recommendation supports ongoing treatment plan adjustments.
- Specify patient condition and rationale for request.
- Detail in case discussion nuances that guided opinion.
- Cite new or continued action steps based on the consultee's recommendations.
