1What Is the C695 OHIP Code?
The C695 code under OHIP is designated for neurodevelopmental consultations typically conducted by psychiatrists. This code is particularly used for inpatient settings where detailed neurodevelopmental assessments are required. Common cases include patients with intellectual disabilities or autism, especially when presenting complex challenges such as aggression or self-injury.
In such settings, these consultations are crucial for tailoring appropriate discharge plans. However, it's important to note that time spent reviewing charts and other non-patient-facing activities do not count toward the consultation time requirements, which can lead to billing errors if not carefully managed.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A190 | Special psychiatric consultation | Unrestricted | Used for consultations requiring a minimum of 75 minutes in direct patient contact. |
| A195 | Consultation | Unrestricted | Standard psychiatric consultations without the extensive requirements of special consultations. |
| A196 | Repeat consultation | Unrestricted | Used for follow-up consultations after an initial consultation. |
| A395 | Limited consultation | Unrestricted | For brief psychiatric consultations or assessments. |
3Eligibility Requirements
The C695 neurodevelopmental consultation can be billed once per two consecutive 12-month periods for the same patient and physician under the same diagnosis. However, if this consultation is conducted for a hospital inpatient over 12 but less than 24 months after the first, it is eligible for a second service in the two-year span. For an unrelated diagnosis, you may bill once every 12 months. Any services exceeding these frequencies will be paid at the general or specific assessment rate.
Virtual Delivery
C695 can be rendered virtually via video only, not via telephone, and should be billed as C695A in such cases.
4What Your Clinical Note Must Show
Consultation notes must clearly document the elements of a neurodevelopmental consultation.
- Patient demographics and referral reason.
- Detailed assessment findings.
- Diagnosis and treatment recommendations.
- Collaboration with other healthcare professionals as needed.
5Weak vs. Strong Note Examples
The strong note documents all necessary elements of the consultation, meets the time requirement, and includes interdisciplinary collaboration, whereas the weak note lacks detail and sufficient justification for a C695 claim.
Patient seen today. Discussed care plan with team. Recommended follow-up.
Patient is a 23-year-old male admitted with aggression in the context of an intellectual disability. Conducted a comprehensive neurodevelopmental assessment to explore potential autism spectrum disorder. Spent 80 minutes in direct patient contact and liaised with nursing staff and family members.
- Detailed observation: Patient's aggressive behavior linked to sensory processing issues.
- Consultation with nursing team revealed patterns of agitation during shift changes.
- Engagement with family highlighted previous strategies for managing behavior.
