1What Is the C384 OHIP Code?
Understanding C384
The C384 billing code is applicable to the Consultation and Management for Acute Cerebral Vascular Syndrome (ACVS) in hospital settings. This service includes thorough patient assessment following a referral, determination of treatment need, and management of therapy such as thrombolysis. Typically, a neurologist provides this consultation to address new focal deficits in an admitted patient, particularly with a suspected cerebrovascular event.
This code is critical during acute scenarios where swift decision-making and treatment initiation, like intravenous thrombolysis, can significantly influence patient outcomes. Despite its importance, it can be overlooked if detailed documentation requirements are not meticulously followed, particularly recording the onset of symptoms and service times.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A180 | Special neurology consultation | As specified in Neurology listing | Used for special cases in neurology requiring comprehensive consultation beyond standard. |
| A185 | Consultation | As specified in Neurology listing | Standard consultation fee for neurology assessments. |
| A186 | Repeat consultation | As specified in Neurology listing | For follow-up consultations under repeated cases. |
| A384 | Consultation and Management for ACVS | Same frequency terms as C384 | Equivalent service for outpatient settings. |
3Eligibility Requirements
Eligibility Requirements
To bill for C384, the following criteria must be met:
- Consultation Elements: All elements of a general consultation must be provided, equivalent to code A185.
- Referral: Must originate from a physician, nurse practitioner, or dental surgeon.
- Setting: Service is rendered in a non-emergency hospital in-patient setting.
- Documentation: Precise start and stop times of the consultation, along with the time of symptom onset, must be documented in the patient's permanent medical record.
- Hospital Facilities: The hospital must have CT or MRI facilities onsite.
- Specialty Requirement: Only eligible when services are rendered by a specialist in Neurology (18).
- Thrombolysis Eligibility: Patient must be within the timeframe for thrombolysis therapy as outlined by the Canadian Stroke Best Practices.
- Repeat Service Conditions: For same diagnosis services, limits are placed on how frequently these can be billed as consultations, primarily one service per two consecutive 12-month periods unless exceptions apply.
4What Your Clinical Note Must Show
Complying with documentation requirements is crucial for billing C384.
- Record the start and stop times of the consultation services.
- Document the time of onset of symptoms in the patient's medical record.
- Ensure the written referral request is stored in the patient’s file.
5Weak vs. Strong Note Examples
The strong note succeeds due to its precise time documentation and clear referral acknowledgment, fulfilling billing code requirements. The weak note fails by lacking these critical details.
Consulted patient for suspected ACVS. Observed usual symptoms, no detailed documentation. Treatment discussed.
Consulted 55-year-old male, onset of right-sided weakness at 10:00 AM, consultation start time 11:15 AM, completed at 12:05 PM.
Referred by Dr. Smith with detailed history attached. Patient eligible for thrombolysis, treated at 11:45 AM.
- Referral confirmed from Dr. Smith, Neurology specialist.
- Patient previously not under thrombolysis, verified with CT scan prior to treatment.
- Documentation complete, meeting all eligibility requirements.
