1What Is the C465 OHIP Code?
What is C465?
C465 is an OHIP billing code for consultations provided by infectious disease specialists, primarily in a non-emergency hospital in-patient setting. This code applies to consultations where a comprehensive assessment is necessitated by the complexity or severity of a patient's infectious disease condition.
Infectious disease consultations via C465 are commonly requested by the ward team to advise on antimicrobial selection or to investigate the source of a fever during a hospital admission. These consultations are critical for patient care, particularly in complex cases with potential for rapid deterioration due to infectious agents.
It is important that C465 is not missed in applicable scenarios, as incomplete or incorrect billing can result in reduced reimbursement rates. Overlooking the specifics of documentation, such as a written referral and record of consultation times, can cause delays in payment or adjustments to a lesser fee.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A275 | Limited consultation | Frequency varies by service | Used for limited consultations with a lower payout than comprehensive consultations. |
| A460 | Comprehensive infectious disease consultation | Frequency varies by service | Used for comprehensive evaluations requiring detailed examination and reporting. |
| A465 | Consultation | Consultation rendered outside of hospital inpatient settings | Equivalent service to C465 rendered outside a hospital inpatient setting. |
| A466 | Repeat consultation | Dependent on necessity for re-evaluation | Used for repeat consultations when ongoing management evaluation is required. |
3Eligibility Requirements
Eligibility for Billing C465
- Setting: The service must be rendered in a non-emergency hospital in-patient setting as outlined in the Infectious Disease listing.
- Consultation Basis: A written request from a referring physician, nurse practitioner, or dental surgeon is required. The consultation must follow a referral with a detailed written report sent back to the referring party.
- Timing and Frequency: Only one consultation per same patient, same physician, same diagnosis is allowed within two consecutive 12-month periods, unless the second service occurs more than 12 but less than 24 months after the first for hospital in-patients or emergency department patients.
- Virtual Care: C465 can be billed for virtual consultations if conducted via video, referenced as C465A. Telephone consultations are not eligible for virtual billing.
- Documentation: Start and stop times of the consultation must be recorded in the patient's medical record. Failure to meet these criteria may result in reduced fees.
For further information, see General Preamble GP40 to GP48 regarding hospital service listings.
4What Your Clinical Note Must Show
To ensure full payment for C465, complete and accurate records are mandatory.
- Record the start and stop times of the consultation in the patient's permanent medical record.
- Include a copy of the written consultation request from the referring professional.
- Maintain detailed notes of the assessment leading to the consultation report.
5Weak vs. Strong Note Examples
The strong note succeeds by providing comprehensive details, referenced start and stop times, and a documented referral and consultation report. The weak note lacks specificity and necessary documentation.
Consultation with patient regarding antimicrobial therapy. Discussed options, no further action.
In-depth consultation with patient on antimicrobial therapy initiated at the request of Dr. Smith. Assessed febrile condition and recommended adjustments to current treatment plan.
Provided detailed report back to the referring physician with recommendations.
- Start Time: 10:00 AM
- End Time: 11:15 AM
- Referral request and consultation report stored in the patient record.
