1What Is the C460 OHIP Code?
What is the C460 OHIP Billing Code?
The C460 code represents a comprehensive infectious disease consultation specifically used in non-emergency hospital in-patient settings. This entails a detailed evaluation by an infectious disease specialist, often necessary for complex cases such as endocarditis, prosthetic joint infections, or multi-drug resistant organisms.
The consultation must consist of at least 75 minutes of direct patient contact where the specialist assesses the patient's medical condition and provides a comprehensive management plan. Such consultations are crucial for tailoring appropriate antimicrobial therapies and addressing the complex needs of patients with serious infections.
Due to its complexity, this service is frequently missed in billing when the consultation fails to meet the required duration of patient-facing time or when documentation falls short. Clear and precise recording practices are essential to capture this service correctly.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A275 | Limited consultation | Various | Used for limited consultations within infectious diseases. |
| A460 | Comprehensive infectious disease consultation | Various | Applicable for comprehensive consultations outside hospital in-patient settings. |
| A465 | Consultation | Various | General infectious disease consultations. |
| A466 | Repeat consultation | Various | Repeat consultations within infectious diseases. |
3Eligibility Requirements
Eligibility Requirements
C460 requires that a comprehensive infectious disease consultation is conducted by a specialist and involves a minimum of 75 minutes of direct patient contact. It cannot overlap with other billable interventions.
Frequency:
- One C460 service per two consecutive 12-month periods for the same patient, physician, and diagnosis.
- A second C460 may be billed within the same two-year period if the second consultation occurs in a hospital setting more than 12 but less than 24 months after the first.
- Where a new, unrelated diagnosis is present, one service is allowed every 12 months.
Documentation: Start and stop times of the consultation must be in the patient's permanent record, or the claim will be adjusted to a lower fee.
C460 services may also be billed as virtual consultations under code C460A; however, they must be video-based, not telephone-based.
4What Your Clinical Note Must Show
Accurate recording of time spent is mandatory.
- Record start and stop times in the patient's permanent medical record.
Ensure all consultation components are documented.
- Include a written report to the referring physician.
Maintain proper records of the referral request.
- Keep a copy of the written request for the consultation signed by the referring provider.
5Weak vs. Strong Note Examples
The strong note succeeds as it includes specific details about the consultation, accurately describes actions taken, and meets the required time duration, unlike the weak note which lacks comprehensive documentation.
Consultation for infectious disease assessment. Duration: 60 minutes. Reviewed patient chart and discussed management.
Conducted comprehensive infectious disease consultation for in-patient suspected of prosthetic joint infection. Reviewed clinical history and diagnostic results, provided antimicrobial strategy. Direct patient interaction lasted 80 minutes.
- Included detailed clinical assessment and findings in report to referring physician.
- Documented start and stop times accurately.
