1What Is the C646 OHIP Code?
What is C646?
C646 is an OHIP billing code used to claim reimbursement for repeat consultations by thoracic surgeons during a patient’s non-emergency hospital inpatient stay. After an initial consultation, it's common for a patient to require further assessment due to changes in their clinical status or to revisit a diagnosis with updated clinical information, such as reassessing an empyema after drainage.
Repeat consultations are crucial in thoracic surgery as they facilitate ongoing patient care and ensure treatments are aligned with any new developments. Accurate billing for these services requires adherence to specific conditions, such as obtaining a new written referral request. This code is commonly missed due to misunderstandings in documentation requirements or failure to secure a proper referral. Understanding and applying the eligibility criteria for C646 is essential for optimal billing.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | Eligible as needed following GP17 rules | A higher-severity consultation requiring advanced assessment. |
| C935 | Special surgical consultation | Eligible as needed following GP17 rules | For special surgical consultative needs within inpatient settings. |
| A645 | Consultation | Once per two 12-month periods, unless a repeat consultation qualifies | Standard consultation for general thoracic surgery. |
| A646 | Repeat consultation | Same requirements as C646, but for out-patient settings | Used for repeat consultations conducted outside of inpatient settings. |
3Eligibility Requirements
Eligibility Requirements for C646
- Setting: Must be rendered as part of non-emergency inpatient services in a hospital setting.
- New Referral: A new written request from the referring physician, nurse practitioner, or dental surgeon is mandatory for each use of C646.
- Documentation: Maintain a copy of the written referral in your medical record, unless conducted in a setting with common medical records.
- Frequency Exclusion: C646 is not subject to the consultation frequency limits stipulated in GP17, thereby making it eligible for multiple visits per clinical need.
- Virtual Delivery: May be billed as C646A for video consultation; telephone consultations are not eligible.
4What Your Clinical Note Must Show
Ensure the following documentation is maintained to comply with OHIP billing requirements:
- Copy of the written referral request signed by the referral source.
- Detailed consultation notes explaining the medical necessity of the repeat consultation.
- Documentation stored in the medical record, unless in a shared medical record setting.
5Weak vs. Strong Note Examples
The strong note succeeds by providing a detailed clinical rationale for the repeat consultation and references the new referral, fulfilling billing requirements.
Reviewed patient with previous empyema treatment. Discussed treatment options. Need further referrals.
Patient presents with exacerbated symptoms following empyema drainage. Reevaluation required due to increased febrile episodes and imaging showing incomplete resolution. Discuss treatment adjustments and consider resection if necessary.
- New referral request attached.
- Documented clinical findings and decision rationale.
