1What Is the C625 OHIP Code?
What is C625?
C625 is a billing code used by allergists and immunologists for consultation services rendered to hospital in-patients. This consultation may be required to evaluate complex immunological conditions such as recurrent infections, severe drug reactions, or suspected primary immunodeficiencies.
Frequently, this code is mistakenly underutilized, with billing teams sometimes overlooking the out-patient equivalent, A625, which is billed at the same fee. Additionally, when the clinical focus is narrower, such as a specific allergy query, C525 (Limited consultation) at a lower fee may be more appropriate.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A525 | Limited consultation | Case-based | Used for narrower scope consultations within Clinical Immunology listing. |
| A625 | Consultation | Same as C625 | For equivalent out-patient consultations. |
| A626 | Repeat consultation | Case-based | Used when a follow-up is required within guidelines. |
| C525 | Limited consultation | Case-based | For limited consultations related to specific immunological queries. |
3Eligibility Requirements
Eligibility for Billing C625
To bill for C625, the following eligibility criteria must be met:
- Service Delivery Mode: Consultations under C625 may be delivered in person or via approved virtual platforms as delineated in Appendix J of the OHIP Schedule of Benefits. Note that only video consultations qualify when delivered virtually.
- Billing Frequency: A typical scenario allows for one consultation per two consecutive 12-month periods per patient, per physician for the same diagnosis. However, if a second consultation occurs as a hospital inpatient or Emergency Department service more than 12 but less than 24 months after the first, it can be billed. Different diagnoses allow billing once every 12 months.
- Settings: Can be billed only for services in hospital in-patient settings, with A625 being the equivalent for out-patient services.
4What Your Clinical Note Must Show
Ensure that the following is documented clearly in the medical records:
- Initial assessment and reasons necessitating the consultation.
- Detailed clinical findings leading to immunological evaluation.
- Rationale for choosing C625 over related consultation codes.
- Details of virtual care, if applicable, including the patient's consent and method of delivery (video only).
5Weak vs. Strong Note Examples
The strong note succeeds by detailing the patient's clinical presentation, the thorough investigation conducted, and the direct outcomes, while the weak note lacks specificity, clinical insight, and actionable results.
Patient presented with symptoms. Discussed immunodeficiency options. No immediate action required.
Patient admitted with recurrent pneumonia and febrile episodes, suspecting primary immunodeficiency.
Full immunological workup performed including laboratory diagnostics.
Previously undiagnosed primary immunodeficiency identified; initiated appropriate immunoglobulin therapy.
- Clear identification of clinical issues prompting consultation.
- Detailed diagnostic assessments performed.
- Definitive diagnostic conclusions and treatment plans.
