1What Is the C655 OHIP Code?
What is OHIP C655?
The OHIP C655 billing code allows hematologists to claim for limited consultations provided to non-emergency hospital in-patients. This code offers a flat fee, acknowledging services that are less demanding than full hematology consultations. It's typically used for presenting a short, focused opinion on specific aspects of care, such as a transfusion or anticoagulation decision, rather than conducting an exhaustive work-up.
Limited consultations are often overlooked due to physicians defaulting to more comprehensive codes or misunderstanding the precise eligibility requirements. Understanding its specific application can ensure accurate and efficient billing.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A615 | Consultation | Standard consultation frequency limits apply | Full hematological consultation. |
| A616 | Repeat consultation | As per standard frequency limits for repeated consultations | Repeat hematological consultation. |
| A655 | Limited consultation | Subject to the same consultation frequency limits as C655 | Out-patient limited hematological consultation. |
| C615 | Consultation | Standard consultation frequency limits apply | Full in-patient hematological consultation. |
3Eligibility Requirements
Eligibility for C655 Billing
- Setting: Non-emergency hospital in-patient services. Always verify the setting aligns with eligibility requirements.
- Consultation Requirements: The service must follow a written request from a referring physician, nurse practitioner, or dental surgeon regarding a specific issue requiring the hematologist's expertise.
- Frequency Limits: The code can be billed once per two consecutive 12-month periods for the same diagnosis, or once within 12 months for an unrelated diagnosis.
- Virtual Care: C655 is eligible for virtual delivery through video only, coded as C655A.
Refer to General Preamble GP40 to GP48 for standard operating procedures and GP65 to GP78 for special considerations around emergency and in-patient services.
4What Your Clinical Note Must Show
Ensure comprehensive documentation of the consultation service.
- Written request from a referring physician, nurse practitioner, or dental surgeon.
- Clear clinical notes detailing the consultation's nature and necessity.
- Recorded decision or advice provided, focusing on one specific aspect like transfusion or anticoagulation.
5Weak vs. Strong Note Examples
The strong note succeeds by detailing the specific clinical question, the rationale behind the advice, and ensuring all referral documentation is complete—factors the weak note lacks.
Consulted on patient X. Discussed treatment. No further notes.
Consulted on inpatient for a focused review of anticoagulation management. Requested by Dr. Y for optimal anticoagulation therapy. Recommended continuation of existing protocol after assessment of recent lab results and patient history.
- Detailed reason for consultation
- Specific advice provided with rationale
- Clear referral and follow-up plan
