1What Is the C316 OHIP Code?
C316 is a billing code specifically designed for repeat consultations within the specialty of Physical Medicine and Rehabilitation in Ontario. It allows physicians to bill for additional consultations with the same patient after initial care has been provided by another physician, typically within a hospital in-patient setting.
In practice, C316 is frequently utilized when there is a significant change in a patient's rehabilitation potential or when new complications arise, such as pressure injuries. This necessitates a new evaluation by the specialist, prompting a second consultation request.
Physicians sometimes miss billing C316 due to oversight in obtaining a new written request for consultation or misunderstanding the requirement for it to follow care rendered by another physician in the interim.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A315 | Consultation | Consultations are limited to one service per two consecutive 12 month periods, except for certain conditions. | Primary consultation service in Physical Medicine & Rehabilitation. |
| A316 | Repeat consultation | Exempt from the regular frequency limits, provided a new written request is made. | Same service as C316 but rendered outside hospital in-patient settings. |
| A425 | Comprehensive physical medicine and rehabilitation consultation | Typically requires comprehensive analysis and is billed at a higher rate. | In-depth initial consultations with expanded requirements. |
| A515 | Limited consultation | Used when a less detailed consultation suffices. | A less comprehensive, lower-cost alternative to the primary consultation. |
3Eligibility Requirements
To be eligible for billing under code C316, several criteria must be met:
- Setting: The service must be provided in a non-emergency hospital in-patient setting.
- Request Requirement: A new written request for consultation must be completed by a referring physician, nurse practitioner, or dental surgeon, and retained in the patient’s record, unless a collective medical record system is employed.
- Frequency Limitations: C316 is excluded from regular consultation frequency limits as outlined in GP17. However, it's imperative to ensure it follows consultation care rendered by another physician in between consultations with the same patient.
- Virtual Care: If delivered virtually, the service must be provided via video (C316A), as telephone consultations do not qualify as comprehensive virtual care.
4What Your Clinical Note Must Show
Maintain the appropriate documentation for all C316 billings.
- Store a signed copy of the referral request from the referring physician, nurse practitioner, or dental surgeon.
- Ensure the request specifies the need for a repeat evaluation due to a change in clinical status or new complications.
5Weak vs. Strong Note Examples
The strong note succeeds due to its clear reference to the reason for the repeat consultation and specific actions taken, whereas the weak note lacks detail and context about the new referral or changed clinical status.
Seen patient for follow-up. Reviewed recent changes in condition.
Repeat consultation conducted upon new referral from Dr. Smith following development of pressure sores. Reviewed changes in the patient's rehabilitation potential.
Detailed assessment and plan adjusted to address new clinical findings.
- Observed deterioration in mobility affecting rehab potential.
- Implemented new wound management protocol based on current condition.
