1What Is the C395 OHIP Code?
C395 is an OHIP billing code specifically for limited psychiatric consultations rendered to hospital in-patients. The focus is on resolving narrow psychiatric questions such as differentiating delirium from psychiatric problems or determining the continuation of psychotropics perioperatively.
This code provides a flat fee of CAD 120.30 and is often misunderstood due to being billed similarly to the repeat consultation code, C196. It is imperative to choose the appropriate billing code based on the nature of the service provided. The full in-patient psychiatric consultation, if appropriate, should be billed under C895.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A190 | Special psychiatric consultation | Subject to consultation frequency limits | Involves comprehensive assessment and management, distinct from limited or repeat consultations. |
| A195 | Consultation | Subject to consultation frequency limits | General psychiatric consultation with intermediate complexity. |
| A196 | Repeat consultation | Subject to consulting physician approval frequency | Applies when follow-up or further evaluation is needed within the same diagnosis context. |
| A395 | Limited consultation | Same frequency limits as C395 | Used for equivalent service rendered outside hospital in-patient settings. |
| C895 | Full in-patient psychiatric consultation | Subject to full comprehensive frequency limits | Covers full in-depth psychiatric evaluation and management in the hospital. |
3Eligibility Requirements
To be eligible for C395, the consultation must be provided to a hospital in-patient and documented as a focused psychiatric assessment. The consultation can be rendered virtually via video (billed as C395A) but is not eligible if conducted via telephone. It is important to adhere to the consultation frequency limits: one service per two consecutive 12-month periods for the same patient with the same diagnosis or once every 12 months for a different diagnosis.
The out-patient equivalent of this service is billed under code A395.
4What Your Clinical Note Must Show
Ensure documentation includes the medium used (video only) and that it complies with virtual care guidelines.
- Clear reason for video consultation.
- Details of patient consent for virtual care.
Verify the frequency of consultations to ensure compliance with OHIP limits.
- One service per two consecutive 12-month periods for the same patient and diagnosis.
- One service every 12 months for a different, unrelated diagnosis.
5Weak vs. Strong Note Examples
The strong note is successful because it specifies the focus of the consultation and includes supporting examination details, whereas the weak note lacks specificity.
Patient referred for psychiatric evaluation. Discussed treatment options. Follow-up recommended.
Completed a limited psychiatric consultation to assess the etiology of the patient's confusion. Differentiated between possible delirium and primary psychiatric disorder.
- Conducted mental status examination supporting findings.
- Documented detailed history of present illness.
