1What Is the C464 OHIP Code?
C464 is a billing code used within the Ontario Health Insurance Plan for medical specific re-assessments conducted by specialists in the infectious disease field. This code applies particularly to hospital in-patients and is typically utilized to adjust treatment plans such as antimicrobial therapy based on new clinical information, like updated culture results or changes in the patient's renal function.
The re-assessment requires a full, relevant history and physical examination of the specific systems affected by infectious diseases. Given the dynamic nature of infectious conditions, timely and thorough re-assessments are crucial for optimizing patient outcomes. However, this code may often be overlooked when not properly documented or when the limits on billing frequency are exceeded.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A463 | Medical specific assessment | Standard use | Initial medical assessment for infectious disease. |
| C463 | Medical specific assessment | Standard use | Initial in-patient assessment for specific infectious diseases. |
| W464 | General re-assessment of patient in nursing home | Standard use | Re-assessment services for patients in nursing homes under the Nursing Homes Act. |
| A461 | Complex medical specific re-assessment | Standard use | Used for more complex infectious disease re-assessments outside hospital settings. |
3Eligibility Requirements
Eligibility Requirements
- Setting: C464 is applicable in non-emergency hospital in-patient services.
- Frequency Limitations: Physicians may bill this code twice per patient within a consecutive 12-month period. Additional claims will be adjusted to a lesser fee unless associated with hospital admissions.
- Virtual Care: C464 can be rendered virtually, billed as C464A, but must be conducted via video. Telephone consultations do not qualify.
- Documentation: Start and stop times of the service must be recorded in the patient's permanent medical record.
4What Your Clinical Note Must Show
It is mandatory to record the time when the service starts and ends in the patient's permanent medical record.
- Record start time of the assessment.
- Record end time of the assessment.
5Weak vs. Strong Note Examples
The strong note succeeds because it details the comprehensive nature of the re-assessment and includes specific start and end times, which meet documentation requirements.
Reviewed patient's lab results. Adjusted medication accordingly.
Re-assessment of patient's response to current antimicrobial therapy completed.
Review included: full history and physical examination focused on infection-related symptoms.
Adjusted treatment plan after evaluating latest culture results and renal function tests as of [date].
- Start time documented as 10:00 AM
- End time documented as 10:45 AM
