1What Is the C355 OHIP Code?
The C355 OHIP billing code is used by urologists for consultations provided to hospital in-patients. In a typical scenario, this involves patients with conditions such as obstructive uropathy, difficult catheter placements, or urosepsis who require a specialist opinion during their hospital admission.
Consultations encompass conducting an assessment and developing a treatment plan or recommendations in response to a written request from a referring healthcare provider. It's crucial to submit proper documentation as consultations can often be confused with routine assessments when the necessary criteria are not clearly met.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | as appropriate | Use for more complex surgical inquiries. |
| C935 | Special surgical consultation | as appropriate | For inpatient surgical consultations. |
| A355 | Consultation | same as C355 | Use the corresponding code for outpatient settings. |
| A356 | Repeat consultation | as appropriate | Use for additional consultations beyond the initial. |
3Eligibility Requirements
To be eligible for billing under C355, the consultation must be a result of a written request from a referring physician, nurse practitioner, or dental surgeon. This request should reflect the complexity or seriousness of the patient's condition and must be preserved in the patient's medical record.
Eligibility is void if the consultation is arranged after the fact or if there is a request for ongoing management post-initial consultation. Consultations can also be billed virtually as C355A, provided they are conducted via video.
Frequency restrictions apply depending on patient setting and consultation history, with certain allowances for hospital in-patients and emergencies. Always refer to the relevant OHIP Schedule of Benefits sections for any exceptions or additional billing criteria.
4What Your Clinical Note Must Show
Ensure comprehensive documentation within the medical record.
- A copy of the written referral from the referring healthcare provider.
- Details identifying the consultant, referring provider, and patient.
- The referral request should outline the service and relevant details.
5Weak vs. Strong Note Examples
The strong note is successful because it thoroughly documents the assessment, findings, and recommendations, while clearly noting the referring provider and reason for referral. The weak note lacks specific details and scope, making it insufficient for billing purposes.
Consultation performed. Awaiting further developments.
Referred by Dr. X.
Consultation requested for patient with complex urosepsis, referred by Dr. Smith.
Assessment included history review, physical examination, and renal function evaluation. Recommendations for catheter management were provided.
- Maintain specific language mentions referring provider and reason for referral.
- Detailed assessment findings and recommendations outlined.
