1What Is the C375 OHIP Code?
C375 represents a limited consultation service provided by geriatricians for hospital in-patients outside of an emergency setting. These consultations are typically less demanding in scope than a full geriatric assessment, often focusing on specific issues such as determining a patient's capacity, a deprescribing decision, or advising on discharge destinations.
This code is crucial in offering timely guidance to inpatient ward teams when a full consultation isn't necessary. Geriatricians might typically use this code when their input is sought regarding a single, focused clinical question rather than a comprehensive assessment.
One common oversight leading to missed billing opportunities with C375 is not recognizing situations where only a specific geriatric evaluation is needed rather than a full consultation.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A070 | Consultation in association with special visit to a hospital in-patient, long-term care in-patient or emergency department patient | Subject to OHIP guidelines on special visit consultations | Used for consultations that occur during a special visit scenario for hospital or emergency settings. |
| A075 | Consultation | Standard OHIP frequency for consultations applies | Used for full geriatric consultations, providing comprehensive evaluation and recommendations. |
| A076 | Repeat consultation | As defined for repeat assessments by OHIP | Allows for an additional consultation if subsequent input is required. |
| A375 | Limited consultation | Frequency rules identical to C375 | Outpatient equivalent of C375 for out-of-hospital settings. |
3Eligibility Requirements
To bill C375, the following eligibility criteria must be met:
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Setting: This service is restricted to non-emergency hospital in-patient settings.
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Frequency: Limited to one service per two consecutive 12-month periods for the same patient, physician, and diagnosis, with one additional service allowable every 12 months for a clearly defined unrelated diagnosis.
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Delivery: Can be rendered virtually via video, billed as C375A. Telephone consultations do not qualify.
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Consultation Requirements: Must be initiated by a written request from a referring physician, nurse practitioner, or dental surgeon connected with an insured dental procedure in a hospital, pursuant to specific clinical needs.
4What Your Clinical Note Must Show
Ensure there is a documented request from one of the following:
- Referring physician
- Nurse practitioner
- Dental surgeon (for insured dental procedures)
Maintain thorough records of the consultation focus:
- Specific issue addressed such as capacity, deprescribing, or discharge planning
- Why a limited consultation was appropriate over a full assessment
For virtual consultations (C375A), ensure:
- Service was delivered via video conferencing
- No telephone consultations billed under this code
5Weak vs. Strong Note Examples
The strong note clearly articulates the consultation's purpose and findings, providing specific clinical information. The weak note lacks detail and fails to capture the reasoning behind the consultation.
Consulted today. Addressed patient's needs.
Consultation purpose:
Assessed patient's decision-making capacity regarding their care plan.
- Referral from Dr. Smith addressing concerns about patient's psychiatric evaluation.
- Evaluation focused on optimizing patient's medication regimen—considered deprescribing unnecessary aspirin.
- Recommendations provided for discharge planning to home with community support.
