1What Is the C715 OHIP Code?
C715 is the OHIP billing code for consultations provided by critical care physicians to non-emergency hospital in-patients. It is used when a critical care assessment is needed due to the complexity or seriousness of a patient's condition. Common scenarios include evaluating patients for organ support, escalation of care, or transfer to the intensive care unit.
Accurate billing requires a comprehensive understanding of the criteria for consultations, as these services are often under-documented. Physicians need to ensure that all consultations are based on a proper referral to avoid reduced payments.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A116 | Repeat consultation | As needed, if criteria met | Use when subsequent consultations for the same issue are necessary. |
| A710 | Comprehensive critical care medicine consultation | As qualified by the case | For extensive, multidisciplinary cases requiring in-depth assessment. |
| A715 | Consultation | Equivalent outside hospital in-patient settings | For similar consults done outside the in-patient environment. |
| A915 | Limited consultation | As clinically indicated | For less complex assessments. |
3Eligibility Requirements
C715 is billable for consultations rendered for non-emergency hospital in-patients in critical care settings. Physicians must obtain a written request from a referring physician, nurse practitioner, or dental surgeon prior to the consultation. For virtual consultations, use billing code C715A, ensuring it occurs via video, as phone calls do not qualify.
Frequency limits dictate that only one service can be billed per two consecutive 12-month periods for the same diagnosis, with some exceptions. In instances where the diagnosis is unrelated, a single consultation may be billed every 12 months. Deviations from these guidelines may result in reduced payments.
4What Your Clinical Note Must Show
Must be kept in the patient's medical record.
- Signed by the referring party.
- Identifies consultant, referring party, and patient details.
- Specifies service(s) required.
Consultation must include comprehensive records.
- Written report to referring party.
- Findings, opinions, and recommendations included.
Required for all consultations.
- Start and end times documented in patient record.
Applicable only to video-conference consultations.
- Phone consultations are not billable under C715A.
5Weak vs. Strong Note Examples
The strong note includes comprehensive documentation, referral details, precise timing, and a thorough report — thus fully supporting the billed service. The weak note is vague, lacking required details and a structured report.
Consultation conducted as requested. Provided suggestions.
Assessment conducted per request from Dr. Smith for critical care evaluation of patient John Doe, due to deteriorating respiratory function.
Initiated organ support recommendations after comprehensive review.
Report sent to Dr. Smith with detailed findings and proposed care plan.
- Date and time of consultation noted.
- Referring physician's details and patient's health number included.
