1What Is the C445 OHIP Code?
What is the C445 OHIP Billing Code?
The C445 code is designated for consultations conducted by oncologists for in-patients in hospitals in Ontario. This code is applicable when a medical oncologist is consulted to assess and set directions for systemic therapy, particularly in cases involving newly discovered malignancies, suspicious masses, or complications related to known cancers.
It’s essential for physicians to recognize that the setting dictates the specific code prefix—C445 for in-patients, A445 for outpatient equivalents, and W445 for long-term care facilities. Although these codes carry the same fee, the correct prefix must align with the treatment setting.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A445 | A445 Consultation | As C445 but for outpatients | Consultation for medical oncology in outpatient settings. |
| A446 | A446 Repeat consultation | Repeat consultations following A445 | For follow-up consultations requiring reassessment after an initial consultation. |
| A845 | A845 Limited consultation | Limited scope, following A445 | Consultations focused on limited patient issues requiring oncological insight. |
| C446 | C446 Repeat consultation | Repeat consultations in hospital settings | Follow-up consultations for hospital in-patients after initial C445 consultation. |
3Eligibility Requirements
Eligibility Requirements for C445
- Virtual Delivery: C445 may be rendered virtually via video, billed as C445A. Consultations conducted over the telephone do not qualify as an eligible Comprehensive Virtual Care Service.
- Frequency: A maximum of one consultation per two consecutive 12-month periods is allowed under the same physician, patient, and diagnosis. An exception exists for an additional consultation in a hospital or emergency setting if rendered more than 12 but less than 24 months after the first.
- Unrelated Diagnosis: If a consultation involves a clearly unrelated diagnosis, it may be billed once every 12 months.
4What Your Clinical Note Must Show
Ensure the following details are documented in the medical records to support billing C445:
- Patient consent for the consultation.
- Clear documentation of the medical necessity and complexity of the case.
- Comprehensive consultation notes including assessment, diagnosis, and treatment direction.
- Virtual consultation notes must indicate video participation.
5Weak vs. Strong Note Examples
The strong note succeeds by providing detailed patient assessments and specific recommendations, which supports medical necessity and billing compliance. The weak note fails due to lack of detail and specifics.
The patient was seen for a consultation regarding their cancer diagnosis.
Consultation conducted on [date] to assess a newly discovered malignancy in the patient admitted for [related/previous condition].
A comprehensive examination was conducted resulting in a recommendation for systemic therapy including [specific treatments].
Patient discussed via video call with consent documented onsite.
- - Type of malignancy and stage documented.
- - Clear mention of new complications or related conditions.
- - Specific oncological recommendations provided.
