1What Is the C346 OHIP Code?
Radiation oncologists use the C346 OHIP billing code when conducting a repeat consultation for a hospital in-patient previously seen. This situation typically arises when there is a re-referral due to new clinical developments such as spinal cord compression symptoms or progression visible in recent imaging studies.
A repeat consultation is crucial in this specialty because it allows a targeted reassessment following interim treatment or diagnostics by other providers. Despite its necessity, this code can be underutilized or missed due to lack of clarity on the written referral requirement, unnecessarily limiting accurate fee claims.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A345 | Consultation | Once every 2 years unless the exception criteria are fulfilled | Initial consultation in radiation oncology, $178.75. |
| A346 | Repeat consultation | Per encounter with new request | Out-patient setting equivalent for repeat consultations, $114.90. |
| A745 | Limited consultation | Per encounter | Shortened clinical consultation in radiation oncology, $114.90. |
| C345 | Consultation | Once every 2 years unless the exception criteria are fulfilled | Initial consultation for in-patient radiation oncology, $178.75. |
3Eligibility Requirements
To bill code C346 for a repeat consultation in radiation oncology, the service must be provided in a non-emergency hospital in-patient setting. Each repeat consultation requires a new written request from the referring physician, nurse practitioner, or dental surgeon. Importantly, the consultation must pertain to the same presenting problem, and it should occur following care by another physician during the interval between the initial and repeat consultations.
For virtual care, C346 can be billed as C346A through a video consultation, but not via telephone. Always ensure that the written request for the repeat consultation is retained in the patient's medical record if no common medical records are available.
4What Your Clinical Note Must Show
Ensure all documentation requirements for C346 are met to avoid downcoding to a lesser assessment.
- Maintain the written request from the referring physician, nurse practitioner, or dental surgeon.
- Include date and reason for consultation in the patient's medical record.
- Verify common medical records maintenance in relevant settings to avoid individual filings.
5Weak vs. Strong Note Examples
The strong note succeeds by clearly stating who referred the patient, documenting the specific clinical changes that prompted the repeat consultation, and detailing the actions taken. The weak note fails due to its vagueness and lack of specifics about the patient's condition or the reason for the repeat consultation.
Patient seen again; referred by Dr. Smith.
Patient re-referred by Dr. Smith for change in symptoms, specifically new spinal cord compression noted on imaging. Completed comprehensive evaluation and developed a new treatment plan.
Consultation stems from significant changes since previous encounter.
Further follow-up scheduled depending on treatment response.
- New symptoms evaluated: spinal cord compression.
- Imaging analysis showed progression requiring reassessment.
- Consultation documented with referring physician's request.
