1What Is the C595 OHIP Code?
What is the C595 OHIP Billing Code?
The C595 billing code applies to limited rheumatology consultations performed on hospital in-patients. It is tailored for situations where a one-time, targeted assessment is needed, such as determining the need for joint aspiration or evaluating medication continuation, without engaging in full-scale inflammatory disease evaluations.
Such consultations are essential for providing specific expertise in a time-efficient manner, typically requiring less physician involvement than comprehensive consultations. Due to its limited scope, this code is often overlooked when documentation does not clearly justify the need for a specialist rheumatology opinion in a hospital setting.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A485 | Consultation | One service per two consecutive 12-month periods, or every 12 months for a new diagnosis | A standard consultation in the rheumatology category, more comprehensive than C595. |
| A486 | Repeat consultation | As per consultation frequency limits for repeated queries on case | Applicable for additional consultations regarding the same diagnosis within specified limits. |
| A590 | Comprehensive rheumatology consultation | Subject to regular consultation frequency; more extensive examinations | For in-depth evaluations requiring significant time and comprehensive assessment. |
| A595 | Limited consultation | Same as C595, but for out-patient settings | Equivalent service for non-in-patient settings. |
3Eligibility Requirements
Eligibility for Using C595
The C595 billing code is applicable under the following conditions:
- Setting: The consultation must be a non-emergency hospital in-patient service, specific to rheumatology.
- Virtual Delivery: Eligible for video consultations, billed as C595A. Telephone consultations are not eligible.
- Consultation Criteria: Requires a written request from a referring physician, nurse practitioner, or dental surgeon in connection with an insured dental procedure rendered in a hospital. The case must present complexity, seriousness, or obscurity necessitating specialist advice.
- Frequency Limits: Limited to one service per patient per two consecutive 12-month periods per physician for the same diagnosis unless an unrelated diagnosis is established.
Be sure to document all criteria accurately in patient records to support the billing.
4What Your Clinical Note Must Show
Ensure the referring physician, nurse practitioner, or dental surgeon provides a written request.
- Details of patient's condition
- Reason for rheumatology opinion
- Patient's relevant medical history
Document the consultation's purpose and outcomes thoroughly.
- Specific question or issue addressed
- Assessment findings
- Recommendations provided
Substantiate the necessity for the limited consultation.
- Complexity or obscurity of case
- Why a limited, as opposed to full, consultation suffices
- Follow-up actions if necessary
5Weak vs. Strong Note Examples
The strong note provides detailed context, clarifies the specific question addressed, and includes clear assessment findings and recommendations, while the weak note lacks specificity and documentation of the thought process.
Patient referred for evaluation. Joint swollen, advised on management.
Patient referred by Dr. Smith for a 65-year-old male with new-onset swollen knee joint.
Consultation focused on determining the necessity of aspiration and evaluating continuation of methotrexate therapy due to possible exacerbation.
- No aspiration deemed necessary at this time, advised on possible alternative anti-inflammatory measures.
- Recommended continuing methotrexate following adjustment to current symptoms.
