1What Is the C405 OHIP Code?
What is C405?
C405 is a billing code under OHIP used for limited consultations in preventive medicine for non-emergency hospital in-patients. It involves providing a short, focused consultation typically addressing a singular issue, such as isolation or contact-tracing queries, as opposed to a comprehensive assessment.
Preventive medicine specialists use this code for situations that require less time and complexity than standard consultations, making it suitable for consultations that don't warrant full-scale assessments. Failure to correctly recognize and utilize this code can result in missed billing opportunities, often because the consultations might seem too concise to warrant formal coding.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A050 | Special community medicine consultation | Not specified | In-depth community medicine consultation, typically more complex. |
| A055 | Consultation | Not specified | General consultation in community medicine. |
| A056 | Repeat consultation | Not specified | Follow-up consultation in community medicine. |
| A400 | Comprehensive community medicine consultation | Not specified | Extensive consultation covering comprehensive assessments. |
3Eligibility Requirements
Eligibility Requirements for C405
To bill C405, the following must be met:
- The consultation must be in a non-emergency hospital setting.
- It should be rendered following a written request from a referring physician, nurse practitioner, or dental surgeon concerning an insured dental procedure in a hospital.
- The purpose is to offer the consulting physician's opinion regarding the complexity, seriousness, or obscurity of a case.
Frequency Limits:
- Only one consultation service for the same patient, physician, and diagnosis is eligible every two consecutive 12-month periods, except when considering repeat consultations.
- If the consultation involves a different diagnosis, it may be rendered once every 12 months.
Consultations should align with the General Preamble requirements GP16 and must not exceed the specified limits to qualify for full reimbursement.
4What Your Clinical Note Must Show
Ensure the following documentation to support billing C405:
- Written request for consultation from a referring physician, nurse practitioner, or dental surgeon.
- Clinical notes detailing the specifics of the consultation, including the issue addressed (e.g. isolation or contact-tracing).
- Consultant's opinion and recommendations documented in the patient’s medical record.
- Adherence to the consultation criteria as per GP16 in the General Preamble.
5Weak vs. Strong Note Examples
The strong note succeeds because it provides detailed context, rationale, and specific recommendations, whereas the weak note is too vague and lacks sufficient details to justify the billing.
Consulted for isolation advice. Provided recommendations.
Consulted regarding patient isolation protocol following exposure to infectious disease at referring physician's request.
Detailed consultation involved assessment of patient's condition, environment, and recommended an isolation strategy specific to the patient's status.
- Referring Physician: Dr. Smith
- Consultation Focus: Isolation protocol post-exposure
- Recommendations: Specific isolation strategy tailored to patient's condition
