1What Is the C475 OHIP Code?
C475 represents a consultation provided by a respirologist to a hospital in-patient requiring expert advice about complex respiratory conditions. Typical scenarios include ventilatory management, pleural effusion evaluations, or oxygen needs assessment. In a hospital setting, this consultation helps provide specialized insights that general medical teams might need to adequately address severe or specialized respiratory conditions.
This code is often missed in cases where consultations are conducted without a proper referral or written documentation by the referring primary care physician or specialist. Appropriate record-keeping is crucial to ensure compliance and successful billing.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A470 | Comprehensive respiratory disease consultation | Variable | Used for comprehensive respiratory consultations. |
| A475 | Consultation | Variable | Equivalent for consultations outside hospital in-patient settings. |
| A476 | Repeat consultation | Variable | Used for follow-up consultations. |
| A575 | Limited consultation | Variable | Applies to limited scope consultations. |
3Eligibility Requirements
- Setting: The service must be rendered as non-emergency hospital in-patient services.
- Referring Party: A written request is mandatory from a referring physician, nurse practitioner, or dental surgeon for a consultation to be valid.
- Frequency: The service is limited to one consultation per two consecutive 12-month periods for the same diagnosis per patient, barring specific exemptions for in-patient scenarios 12-24 months apart.
- Virtual Delivery: C475 may be billed as C475A for video-only virtual consultations. Telephone consultations do not qualify under this code for virtual service billing.
4What Your Clinical Note Must Show
The following documents must be retained as part of the medical record for billing C475.
- A written referral from a qualified referring practitioner.
- Consultation details including patient name and health number.
- Written report with findings and recommendations sent to referring practitioner.
Precise time logging is crucial.
- Record start and end time of the consultation in the patient's medical chart.
5Weak vs. Strong Note Examples
The strong note specifies the written request and outlines the detailed areas of clinical assessment and collaborative planning, while the weak note lacks specific details and clinical justification.
Consultation regarding patient's respiratory status conducted. Recommendations given.
Consultation conducted upon written request from Dr. Smith. Patient with complex pleural effusion issues requires specialized interventional plan and revised ventilatory support.
- Evaluation of ventilation parameters.
- Assessment of pleural effusion type and management plan.
- Collaboration with treating team to adjust therapeutic approach.
