1What Is the C365 OHIP Code?
What is the C365 Billing Code?
C365 refers to a Special Interventional Radiological Consultation within the Ontario Health Insurance Plan (OHIP) fee schedule. This code is used when a radiologist performs a complex and lengthy consultation, necessitating a minimum of 50 minutes of direct patient contact.
Often utilized in hospital in-patient settings, these consultations typically involve detailed assessments prior to complex interventional procedures, where thorough discussion of risks and alternatives is required. Due to the specific and demanding nature of such cases, documentation must reflect the complexity to justify the billing of C365.
The service is sometimes missed in cases where the physician might under-document the required time or where the consultation does not meet the defined complexities, thereby defaulting to a lesser code.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A335 | A335 Consultation | One service per patient per day. | Standard consultation within the Diagnostic Radiology listing. |
| A365 | A365 Special Interventional Radiological Consultation | Same frequency as C365 for non-hospital settings. | Equivalent special consultation for out-patient settings. |
| C335 | C335 Consultation | One service per patient per day. | Standard consultation under hospital settings in Diagnostic Radiology. |
| A331 | A331 Minor Assessment | Unlimited within medical necessity constraints. | Short assessment within the Diagnostic Radiology listing. |
3Eligibility Requirements
Eligibility Requirements for C365
- Consultation Definition: The C365 code is applied when a consultation is performed that meets the same conditions as the A365 classification in diagnostic radiology settings.
- Time Requirement: A minimum of 50 minutes of direct patient contact is required. This time is exclusive of any other remunerated services.
- Referral and Documentation:
- Must be initiated upon a written request from a referring physician, nurse practitioner, or dental surgeon, and address complex, obscure, or serious patient issues.
- The consultation must result in a written report which includes findings, opinions, and recommendations sent to the referring provider.
- Billing Frequency: This service can be billed once per two consecutive 12-month periods. Exceptions apply for hospital in-patients if the second consultation occurs between 12-24 months after the initial consultation.
- Video Delivery Option: C365 may be rendered virtually, but only through video consultation, indicated by C365A.
4What Your Clinical Note Must Show
Ensure to maintain comprehensive records for compliance and billing validation:
- Written request for consultation from a referring professional.
- Documented start and end times of patient direct contact.
- A thorough report with findings and recommendations sent to the referrer.
5Weak vs. Strong Note Examples
The strong note provides a clear narrative and comprehensive details that justify the extensive nature of the consultation, covering all aspects of the service, while the weak note lacks specificity and detail.
Consultation on complex case conducted. Discussed options. 50 minutes spent.
Conducted a detailed consultation regarding potential endovascular procedure. Patient assessed for 50 minutes to explore possible complications and alternatives considering the significant vascular obstruction noted.
Communicated findings and step-by-step recommendations on patient management in the comprehensive report sent to Dr. Smith.
- Reviewed patient history and imaging.
- Detailed discussion on procedural risks and alternatives.
- Provided a comprehensive consultation report.
