1What Is the C471 OHIP Code?
C471 is an OHIP billing code used for complex medical specific re-assessments performed by respirologists in non-emergency hospital in-patient settings. Patients experiencing significant changes in their respiratory condition that necessitate repeated evaluations can have these re-assessments billed under C471, provided they are within the frequency limits.
In the clinical context of respirology, this code addresses the need for close monitoring of conditions like fluctuating respiratory failure. Failure to appropriately document the timing of assessments or exceeding the four-per-12-month limit are common reasons for denied claims.
Physicians must ensure assessments meet the criteria of complexity, obscurity, or seriousness, as outlined in OHIP's General Preamble, to successfully use this code.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A473 | Medical specific assessment | Not specified | General respiratory specific assessments, higher fee than C471. |
| C473 | Medical specific assessment | Not specified | Respiratory specific assessments in non-emergency settings. |
| A471 | Complex medical specific re-assessment | Not specified | Equivalent service in out-patient settings, slightly higher fee. |
| A474 | Medical specific re-assessment | Not specified | Standard re-assessment for less complex cases. |
3Eligibility Requirements
Eligibility Requirements for C471
- Setting: Non-emergency hospital in-patient services, specifically listed under the Respiratory Disease (47) category.
- Frequency: Limited to four complex medical specific re-assessments per patient, per physician, within a 12-month period. This includes any combination of medical and complex medical specific assessments.
- Virtual Delivery: Can be billed as C471A when delivered via video. Telephone-based consults are not eligible.
- Documentation: Accurate recording of the start and end times for each assessment is required on the patient’s permanent medical record. Failure to do so will result in non-payment.
4What Your Clinical Note Must Show
Accurate and thorough documentation is essential for successful billing.
- Record the start and end times of the assessment in the patient’s permanent record.
- Ensure the complexity or seriousness justifies the re-assessment under C471.
- Indicate any changes or developments in the patient's condition warranting the complex re-assessment.
5Weak vs. Strong Note Examples
The strong note includes specific details on timing, changes in the patient's condition, and explicit steps taken in the treatment plan, which fully justify the complex re-assessment billing.
Reviewed patient for respiratory concerns. Assessment lasted 30 minutes. Decision: further monitoring.
Re-assessed patient due to worsening respiratory failure. Start: 10:00 AM; End: 10:35 AM.
Observed increased dyspnea and oxygen requirement. Modified treatment plan to include supplemental high-flow oxygen and additional respiratory support.
- Detailed time documentation.
- Specific changes in patient's condition.
- Clear description of modified treatment plan.
