1What Is the C616 OHIP Code?
A repeat consultation under OHIP Billing Code C616 refers to an additional evaluation by the same hematologist for a non-emergency in-patient within a hospital setting. This occurs after an initial consultation and subsequent treatment by another physician for the same presenting problem. Typically, a repeat hematology consultation is triggered when a patient's condition, such as blood counts or bleeding issues, changes unexpectedly.
Hematologists frequently perform these consultations in hospital wards, where they reassess patients based on new developments in their hematological conditions. Due to the need for new written requests for each consultation, it’s crucial to maintain proper documentation to support these claims.
It's often overlooked that each repeat consultation must follow an interval of care by another healthcare provider, necessitating scrutiny of patient records and inter-physician communication.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A615 | A615 Consultation | Variable | General consultation in hematology settings, billed at $192.90. |
| A616 | A616 Repeat consultation | Variable | Out-patient equivalent of the C616, billed at $118.05. |
| A655 | A655 Limited consultation | Variable | Limited hematology consultation, billed at $118.05. |
| C615 | C615 Consultation | Variable | Initial inpatient consultation in hematology settings, billed at $192.90. |
3Eligibility Requirements
To be eligible for billing under OHIP Code C616, the consultation must be a non-emergency hospital in-patient service, provided in a hematology setting. A new written request from a referring physician, nurse practitioner, or dental surgeon is mandatory and should be retained in the consulting physician's records unless shared medical records are used.
C616 consultations can be delivered virtually, but only through video services, as telephone consultations are not included as eligible virtual care services under this code.
4What Your Clinical Note Must Show
Maintain a written consultation request in the medical record for each repeat consultation.
- Signed by referring physician, nurse practitioner, or dental surgeon
- Store in the consulting physician's medical records unless common records are used
5Weak vs. Strong Note Examples
The strong note succeeds because it includes specific details about the patient's changed condition and documents the written request and clinical actions taken, whereas the weak note fails to detail the consultation's necessity or reference proper documentation.
Patient seen for repeat consultation. Discussed treatment options.
Patient referred back to hematology due to new bleeding problems. Received a detailed written request from Dr. Smith, noted in the file.
Discussed changes in patient's condition since last seen and provided updated management plan.
- Reviewed laboratory results indicating change in blood count.
- Detailed patient progress and next steps with follow-up recommendations documented.
