1What Is the C615 OHIP Code?
What is the C615 OHIP Billing Code?
C615 is an OHIP billing code used by hematologists for consultations in non-emergency hospital in-patient settings. This code is applied when a hematology consultation is requested by a referring physician, nurse practitioner, or dental surgeon due to the complexity or obscurity of a patient's medical condition.
In the hematology specialty, typical scenarios might involve advising on falling platelet counts, transfusion decisions, or managing anticoagulation in admitted patients. It's a comprehensive assessment that provides a detailed analysis and recommendations, which are then communicated in a written report to the referring healthcare professional.
It's crucial to note that a consultation request must be documented and meet specific criteria, otherwise reimbursement may be reduced.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A615 | A615 Consultation | One service per two consecutive 12-month periods; two services if second is in inpatient/ED context | Applies to consultations performed outside hospital in-patient settings. |
| A616 | A616 Repeat Consultation | Eligible for billing in follow-up scenarios | Repeat consultation after the initial assessment or when ongoing management is required. |
| A655 | A655 Limited Consultation | Can be billed when a limited scope of consultation is sufficient | Applies to less comprehensive assessments than a full consultation. |
| C616 | C616 Repeat Consultation | Eligible for billing for follow-up consultations in hospital in-patient settings | Used for repeat consultations following an initial assessment. |
3Eligibility Requirements
Eligibility for Billing C615
To bill C615, the following conditions must be met:
- Consultation Setting: Must be performed in a non-emergency hospital in-patient environment.
- Referral Requirement: A written consultation request from a referring physician, nurse practitioner, or dental surgeon is mandatory. This referral should indicate the reasons for consultation and must be retained in the medical records unless common records are maintained in the institution.
- Frequency Constraints: C615 can be billed once per two consecutive 12-month periods for the same diagnosis and patient unless the second service is provided in a hospital or ER more than 12 but less than 24 months after the first. For unrelated diagnoses, one consultation every 12 months is permitted.
- Virtual Care: The consultation can be conducted via video (C615A) but not by telephone.
Failure to meet these criteria can result in the consultation fee being downgraded to a general assessment fee.
4What Your Clinical Note Must Show
Ensure these documents are included in the patient's medical record:
- Written request for the consultation from the referring practitioner detailing the specific reasons for consultation.
- Clear identification of the consultant and the referring practitioner, including their names and billing numbers.
- Patient identification, including full name and health number.
- Documented findings, opinions, and recommendations in a written report sent to the referring practitioner.
5Weak vs. Strong Note Examples
The strong note succeeds because it provides a detailed account of the assessment, tests, and recommendations, includes all necessary identifiers and documentation, and has clear time tracking. The weak note lacks detailed findings and comprehensive documentation.
Consult requested for hematology opinion. Discussed general thoughts, awaiting further input.
Date of Consultation: [Insert Date]
Time: Start [Insert Time] - End [Insert Time]
Referring Physician: Dr. Smith, Billing #123456
Patient: John Doe, Health #987654321
Consultation Details: Conducted a comprehensive assessment of falling platelet count and potential transfusion. Evaluated patient history, conducted necessary tests, and developed recommendations for treatment strategy.
- Assessment notes include detailed patient history and all tests conducted.
- Recommendations are clearly outlined and justified based on findings.
- All required identifiers and referral documentation are present and complete.
