1What Is the C435 OHIP Code?
The C435 billing code is used for limited consultations in the internal medicine setting, especially for in-patients. It typically covers scenarios where a physician addresses a narrow clinical question, such as interpreting an abnormal test result or determining the resumption of chronic medications post-surgery, without a full internal medicine assessment.
This code is often missed when the patient's condition requires a comprehensive assessment instead. In cases requiring a more in-depth evaluation, it may be more appropriate to bill code C135.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A130 | Comprehensive internal medicine consultation | One per 12-month period per patient | Involves a comprehensive assessment of the patient by internal medicine specialists. |
| A135 | Consultation | As clinically required | For situations demanding a detailed evaluation in internal medicine. |
| A136 | Repeat consultation | One per patient per 12-month period after the initial consultation | Covers subsequent consultations following the comprehensive one within the year. |
| A435 | Limited consultation | As per C435 guidelines, outside hospital settings | Equivalent service rendered outside hospital settings. |
3Eligibility Requirements
C435 may be rendered virtually and billed as C435A, but only under the "VIDEO ONLY" category. Telephone consultations are not eligible under this code. This service applies to in-patients and has an out-patient equivalent of A435.
The billing frequency for C435 is limited to one service per physician, patient, and diagnosis combination every two consecutive 12-month periods. Furthermore, the service is eligible once every 12 months for clearly defined unrelated diagnoses.
4What Your Clinical Note Must Show
Ensure the documentation captures key elements for in-patient limited consultations.
- Patient's name and OHIP number
- Date and time of service
- Narrow clinical question addressed
- Physician's assessment and plan
- Reason for not providing a comprehensive consultation
5Weak vs. Strong Note Examples
The strong note succeeds because it provides specific details about the clinical question and outlines the physician's decision-making process. The weak note lacks detail and specificity.
Consulted for abnormal lab result.
Advised no change in current management.
Patient presented with a newly identified elevated liver enzyme, ALT.
Reviewed patient's chart and medications post-cholecystectomy.
Concluded the elevation likely transient post-surgical change, no immediate intervention required.
- Outlined rationale for no change in medication.
- Documented communication with surgical team.
