1What Is the C590 OHIP Code?
The C590 code is used to bill for a comprehensive rheumatology consultation provided by a specialist for an in-patient in a hospital setting. This type of consultation is often necessary for complex cases such as suspected vasculitis, systemic lupus flares, or acute inflammatory arthritis.
Physicians specializing in rheumatology utilize this code when a consultation requires a minimum of 75 minutes of direct patient contact. It is essential for providing thorough evaluation and forming a treatment plan for complex rheumatologic conditions in a hospital context.
C590 can be overlooked if the consultation details, such as the start and end times, are not properly recorded, or if the service itself is confused with simpler consultations that have different billing codes.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A485 | Consultation | As required | Standard consultation for rheumatology listed at $202.40. |
| A486 | Repeat consultation | As required | For follow-up consultations in rheumatology listed at $125.10. |
| A590 | Comprehensive rheumatology consultation | Same criteria as C590 for non-inpatients | Equivalent to C590 but for non-hospital in-patient settings. |
| A595 | Limited consultation | As required | Simpler consultations not requiring extensive time or complexity, listed at $124.50. |
3Eligibility Requirements
To bill using C590, the following conditions must be met:
- The consultation must be requested in writing by a physician, nurse practitioner, or dental surgeon, significant enough to warrant the advice of a specialist.
- A minimum of 75 minutes must be spent in direct contact with the patient, and this must be documented.
- A written report detailing findings, opinions, and recommendations must be sent to the referring professional.
- C590 consultations can occur once every two consecutive 12-month periods per patient with the same physician and diagnosis. An exception allows for two consultations within the two-year period if one is conducted as an inpatient or in an emergency department 12 to 24 months after the first.
- This service is eligible for virtual delivery via video, not phone calls, under the designation C590A.
4What Your Clinical Note Must Show
Detailed records must be maintained to support the billing of C590.
- Record the start and stop times of the consultation.
- Ensure the consultation meets the minimum 75-minute contact requirement.
- Maintain a copy of the referral request.
- Provide a written report to the referring physician, NP, or dentist.
5Weak vs. Strong Note Examples
The strong note provides precise timing, specific clinical details, and confirmation of a report, ensuring compliance with billing requirements.
The consultation began, was lengthy, and involved various discussions with the patient. Recommendations were provided.
Comprehensive rheumatology consultation initiated at 10:00 AM and concluded at 11:30 AM. Patient presented with acute inflammatory arthritis, requiring detailed assessment and intervention. A 90-minute direct interaction involved physical examination, lab review, and consult on treatment plan. Written report submitted to Dr. Smith.
- Clearly documents start and end times.
- Specifically mentions the clinical focus and findings.
- Includes an outcome with a report back to the referrer.
