1What Is the C335 OHIP Code?
C335 is an OHIP billing code for consultation services provided by radiologists for hospital in-patients. This service is typically employed when healthcare providers in a hospital setting require expert radiological opinions on complex cases or prior to interventional procedures. C335 consultations may include: guidance on urgent radiological studies or pre-procedural evaluations. However, second opinions on CT and MRI studies require separate billing codes.
This consultation code ensures that the services rendered by radiologists are adequately captured and compensated in scenarios where an expert is called to provide crucial insights in real-time or complicated diagnostic situations. Failing to document or request consultations appropriately could result in claims being denied or reduced to lesser assessments.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A335 | A335 Consultation | as defined for C335 | Out-patient equivalent consultation service in diagnostic radiology. |
| A365 | A365 Special interventional radiological consultation | subject to specific rules | Special interventional consultation for complex radiological procedures. |
| C365 | C365 Special interventional radiological consultation | subject to specific rules | For in-patient special interventional radiology consults. |
| A331 | A331 Minor assessment | as needed | For basic assessments in diagnostic radiology. |
3Eligibility Requirements
To be eligible for billing under C335, the following conditions must be met:
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Written Request Requirement: A consultation must be initiated following a written request from a referring physician, nurse practitioner, or dental surgeon connected to a hospital-based procedure. The written request should include the requesting and consulting physician's names and billing numbers, patient details, and specific service(s) required.
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Frequency Limits: Consultations for the same diagnosis with the same patient are limited to one per two consecutive 12-month periods. Exceptions exist for in-patients or emergency situations occurring 12–24 months after the initial consultation or consultations for unrelated diagnoses.
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Setting: C335 is applicable to non-emergency hospital in-patient services and can be rendered via video, though telephone consultations do not qualify.
4What Your Clinical Note Must Show
A written request must be documented in the medical record.
- Consultant's name and specialty.
- Referring provider's name and billing number.
- Patient's name and health number.
- Relevant information and services requested.
The consultation requires a written report by the consultant.
- Report must include findings, opinions, and recommendations.
- Must be sent back to the referring provider.
5Weak vs. Strong Note Examples
The strong note succeeds by including comprehensive details and maintaining clear communication channels, ensuring it meets all billing requirements effectively.
Request received for consultation. Patient details not fully documented. No clear indication of services needed.
Received request for urgent radiological consultation from Dr. Smith, requesting a second opinion on urgent interventional procedure.
Patient: John Doe, Health#: 123456789
Study and findings attached as per request.
Consultation Report will follow upon completion of review.
Contact for discussing further findings: Dr. Smith (Billing#: 987654321)
- Attached relevant radiographs and imaging details.
- Detailed notes on time of consultation.
- Clear communication pathway for post-consultation follow-up.
