1What Is the C345 OHIP Code?
C345 is the OHIP billing code for consultations provided by radiation oncologists specifically to hospital in-patients. This code is used when a patient is assessed for conditions that require urgent oncological intervention, such as spinal cord compression, uncontrolled bleeding, or severe bone pain.
Consultations under this code are critical in cases requiring immediate attention and evaluations necessary to guide decisions on palliative radiotherapy. The applicability and reimbursement for this code is partly determined by the immediate necessity and complexity of the patient's condition.
The code might be frequently overlooked due to misunderstandings of its applicability or failure to meet stringent documentation requirements necessitating comprehensive referrals and consultative reports.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A345 | A345 Consultation | As specified in the Radiation Oncology listings | Consultation in outpatient settings in radiation oncology. |
| A346 | A346 Repeat consultation | As eligible, in Radiation Oncology listings | Repeat consultation in outpatient settings. |
| A745 | A745 Limited consultation | As eligible, in Radiation Oncology listings | Limited scope consultation service. |
| C346 | C346 Repeat consultation | As eligible within the applicable periods | Repeat consultation in inpatient settings. |
3Eligibility Requirements
To bill OHIP under code C345, the consultation must be rendered in a non-emergency hospital in-patient setting for radiation oncology. The consultation requires a written referral from a physician, nurse practitioner, or dental surgeon indicating the need for a radiation oncologist's opinion due to the complexity of a case or on the request of the patient. The documentation must include:
- A written consultation request signed by the referring professional.
- Identification of the consultant and referring professional by name and billing number.
- Specific patient identification and health number.
- Clear statement of the issues leading to referral.
Frequency limits include one service per two consecutive 12-month periods for the same patient, diagnosis, and physician, with certain exceptions allowing an additional consultation. If documentation does not meet required standards, the service may be compensated at a lower assessment rate.
4What Your Clinical Note Must Show
Ensure these documents are maintained in the patient's medical record:
- Written consultation request with referring professional's signature.
- Clear identification of consulting and referring professionals.
- Accurate patient details including health number.
- Detailed reason for the consultation with specified service requirements.
5Weak vs. Strong Note Examples
The strong note succeeds by providing thorough patient assessment details and attaching a specific, signed referral document, aligning with OHIP criteria. The weak note fails in specificity and completeness, risking reduced fee reimbursement.
Patient assessed for radiation therapy.
Referral not specified in detail.
Limited documentation on patient's diagnosis.
Patient evaluated for suspected spinal cord compression requiring urgent radiation therapy.
Referral included from Dr. John Smith, clearly indicating the need for oncologist intervention due to rapid decline in motor function.
Consultation report completed with specific treatment recommendations.
- Includes thorough assessment of patient's symptoms and results.
- Specifies the need for and outcome of consultation with documentation of the written referral.
