1What Is the C680 OHIP Code?
The C680 billing code pertains to the initial assessment of substance abuse conducted by physicians, primarily in a hospital in-patient setting. It is designed for situations where a patient is admitted due to withdrawal, overdose, or other medical complications arising from substance use. This comprehensive assessment sets up treatment plans before discharge.
It's important for physicians to note that this code is subject to the same conditions as A680, including the once-per-patient-per-practice-group rule within a 12-month period. One common oversight is not recognizing that C680 cannot be billed if an A680 assessment was conducted by the same physician or practice group within the last year. Additionally, assessments related to smoking cessation are not eligible under this code.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A680 | 'A680 Initial assessment - substance abuse' | Once per patient per physician or group every 12 months | Equivalent service outside of hospital in-patient settings. |
| A914 | 'A914 GP focused practice comprehensive consultation by Video' | For comprehensive virtual consultations | Enables focused practice consultations through video for general practice. |
| A006 | 'A006 Repeat consultation' | Multiple use, per assessment needs | Follow-up consultations. |
| A010 | 'A010 GP focused practice consultation by Video' | Can be billed per consultation | Non-comprehensive general practice consultations done via video. |
3Eligibility Requirements
Eligibility
- Frequency Limit: C680 is limited to once per patient per physician or practice group within a 12-month period, unless an exception applies where more than 12 months have passed since the last service.
- Exclusion: The assessment cannot be billed for substance abuse in relation to smoking cessation. For services related to smoking cessation, refer to codes like A957, K039, and E079.
- Practice Group Definition: Practice group refers to physicians within the same billing group or those co-located with shared access to patient medical records.
- Virtual Care: C680 can be conducted virtually but must be performed via video (C680A); telephone consultations are not eligible.
- Time Calculation: Excludes time dedicated to other billable services or non-patient-facing activities like reviewing documentation.
4What Your Clinical Note Must Show
Ensure the following details are accurately documented in the patient's medical record:
- Patient's medical history and details leading to the in-patient admission.
- Comprehensive substance use assessment and findings.
- Treatment plan formulated during the initial assessment.
- Documentation of any co-existing medical complications or conditions.
5Weak vs. Strong Note Examples
The strong note provides a detailed clinical picture, outlines the assessment process, and proposes a treatment plan, while the weak note lacks specifics necessary for billing justification.
Patient admitted for substance use. Initial assessment done.
53-year-old male admitted for opioid overdose complicated by pneumonia. Initial comprehensive assessment conducted covering history of substance use, previous treatments, and psychological assessment. Developed treatment plan focusing on pharmacotherapy and behavioral interventions. Collaboration with in-patient care team for safe discharge planning.
- Documented specific substances used and frequency.
- Included relevant psychosocial factors impacting patient's substance use.
