1What Is the C635 OHIP Code?
Overview of C635
The C635 billing code is used for consultations conducted by nuclear medicine specialists in a non-emergency hospital in-patient setting. This service involves assessing patients for suitability for radionuclide studies or therapies, or interpreting unexpected scan findings in a clinical context.
This consultation requires a referring request, and the consulting nuclear medicine physician must prepare a detailed written report for the referring practitioner. It's often missed due to a failure in fulfilling documentation requirements or misunderstanding eligibility criteria.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A635 | A635 Consultation | As C635, outside hospital settings | Nuclear medicine consultation for out-patient services. |
| A636 | A636 Repeat consultation | Varies based on circumstances | Used for repeat nuclear medicine consultations. |
| A735 | A735 Diagnostic consultation | One service per request | Diagnostic consultation within nuclear medicine. |
| A835 | A835 Comprehensive nuclear medicine consultation | Varies based on circumstances | For complex and comprehensive nuclear medicine consultations. |
3Eligibility Requirements
Eligibility for C635
- Setting: C635 is for non-emergency hospital in-patient services within the nuclear medicine specialty.
- Documentation: A written request from a qualified referring practitioner is mandatory. This request must include the consultant's name/specialty, referring practitioner's details, and patient's information.
- Frequency Limits: One service per two consecutive 12-month periods for the same patient, physician, and diagnosis. Exceptions allow a second service when the second is performed in a hospital or ED setting, more than 12 but less than 24 months after the first. For unrelated diagnoses, one service every 12 months.
- Virtual Delivery: Eligible for video but not telephone consultation; billed as C635A.
Consultations that do not meet these criteria may be paid at a general assessment rate.
4What Your Clinical Note Must Show
The following elements must be documented in the patient's medical record for a C635 consultation to be billable:
- A copy of the written consultation request, signed by the referring practitioner.
- Identification of the consultant and the specialty being consulted.
- Details of the referring physician, nurse practitioner or dental surgeon by name and billing number.
- Patient identification including name and health number.
5Weak vs. Strong Note Examples
The strong note is successful because it includes a precise account of the consultation, comprehensive documentation of the request, and preparation details. The weak note lacks these elements and does not meet basic documentation requirements.
Consulted patient about nuclear scan. Verbal referral received, will send report later.
Consulted patient for suitability for radionuclide therapy.
Written request received from Dr. Smith (Referring ID: XYZ123) for comprehensive evaluation regarding atypical scan findings.
- Detailed clinical findings included.
- Pre-consultation requests attached.
- Completed written report synopsis: patient responded positively to radionuclide proposal, no unusual reactions. Will forward full report to referring practitioner.
