1What Is the C400 OHIP Code?
What is the C400 Code?
C400 refers to a comprehensive community medicine consultation provided by a specialist in community medicine. This service is applicable in cases where a patient in a hospital setting presents with complex public health issues, such as reportable communicable diseases requiring expert assessment.
The consultation must include all requisite elements of a typical consultation, extend over a minimum of 75 minutes in direct patient contact, and exclude time spent on separately billable activities or non-patient-facing tasks.
Due to the specialized nature and time requirements, C400 consultations are most commonly missed when time tracking is not diligently recorded or when parts of the consultation documentation are incomplete.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A050 | Special community medicine consultation | As specified under special conditions | Community medicine consultation at a reduced fee with less stringent guidelines than C400. |
| A055 | Consultation | As needed, based on specific requirements | Standard consultation in community medicine with general protocols. |
| A056 | Repeat consultation | As needed, subset rules apply | Repeat service consultation in community medicine under specified conditions. |
| A400 | Comprehensive community medicine consultation | Equivalent service, out-patient setting | Out-patient equivalent of C400 with the same eligibility requirements but different setting. |
3Eligibility Requirements
Eligibility Requirements for Billing C400
To bill using the C400 code:
- The service must be rendered by a specialist in community medicine and involve at least 75 minutes of direct patient clinical engagement.
- Frequency is limited to one per two consecutive 12-month periods for the same patient and physician, and same diagnosis. Two services may be billed in the same period if the second consultation is rendered in a hospital setting more than 12 but less than 24 months after the first consultation.
- The start and stop times of the consultation must be recorded in the patient's permanent medical record.
- C400 can be billed for different diagnoses every 12 months.
- A formal written request from a referring physician, nurse practitioner, or dental surgeon is required, identifying both consultant and patient and detailing the specific service needs.
4What Your Clinical Note Must Show
Accurate record-keeping is critical to compliance with C400 billing requirements.
- Begin and end times of the consultation must be documented.
- Maintain a copy of the written consultation request in the patient's medical record.
- Ensure all consultation elements are satisfied as per the general preamble.
5Weak vs. Strong Note Examples
The strong note includes precise start and stop times, identification of the referring physician, and documentation of comprehensive consultation elements, ensuring compliance with OHIP billing requirements.
Consultation conducted to address public health concern. Time spent: approximately 1 hour.
Comprehensive consultation conducted for a hospital in-patient case involving reportable communicable disease per referral request from Dr. Smith (Referring ID: 123456).
- Start Time: 09:00 AM
- End Time: 10:30 AM
- All consultation elements fulfilled and documented.
