1What Is the C735 OHIP Code?
What is OHIP Code C735?
C735 is a billing code under the Ontario Health Insurance Plan (OHIP) used by nuclear medicine specialists when conducting a diagnostic consultation for hospital in-patients. This service consists of a detailed assessment following a written request from a referring healthcare provider, providing an expert opinion on complex nuclear medicine-related diagnoses, such as suspected osteomyelitis or pulmonary embolism.
Diagnostic consultations in this context are often sought when nuclear imaging studies are ambiguous, requiring specialist input to guide the patient's subsequent management. This service is indispensable in ensuring thorough and accurate interpretation of imaging results and advising on further clinical actions.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A635 | Consultation | Subject to standard consultation rules | Used for initial nuclear medicine consultation services. |
| A636 | Repeat consultation | Two consultations per year, unless specific rules apply | Applies to subsequent nuclear medicine consultations. |
| A735 | Diagnostic consultation | Same as C735 but for services outside hospital settings | Applies to diagnostic consultations outside hospital settings. |
| A835 | Comprehensive nuclear medicine consultation | Defined by complexity and scope of service required | Covers broad and complex nuclear medicine consultations. |
3Eligibility Requirements
Eligibility for C735 Billing
To bill for C735, the following eligibility criteria must be met:
- Referring Source: The service must be initiated following a written request from a referring physician, nurse practitioner, or dental surgeon.
- Setting: C735 applies to diagnostic consultations performed for hospital in-patient services outside emergency settings.
- Consultation Details: The consultation must be rendered based on nuclear medicine services performed at a different institution, requiring a nuclear medicine specialist's expert opinion at another facility.
- Billing Frequency: Generally, one consultation is payable per two consecutive 12-month periods per patient, per diagnosis, unless the consultation occurs more than 12 months after a prior one in an emergency or inpatient setting.
- Documentation: The specialist must maintain a copy of the written request, detailing all necessary information about the referring and consulting parties, as well as patient identification details.
4What Your Clinical Note Must Show
Ensure all the following documentation is recorded accurately to support C735 billing.
- Written request from a referring healthcare provider, with their name and billing number.
- Identification of the consulting physician and their specialty.
- Patient's full name and health number.
- Details of the consultation request, including specified services required.
- Retention of a signed copy of the consultation request in the patient's medical record.
5Weak vs. Strong Note Examples
The strong note succeeds by thoroughly documenting the consultation process and fulfilling all necessary administrative requirements, whereas the weak note fails to provide sufficient information or meet eligibility criteria.
Brief note stating: 'Consulted on possible infection, report sent.' Lacks detail on the request source or specifics.
Comprehensive documentation of the consultation process, including purpose, findings, and recommendations, as well as:
- Written request details attached.
- Exact start and end time of the consultation recorded in the patient's file.
- Detailed consultation report feedback to the referring physician.
- Referring physician's name and details clearly listed.
- Specific nuclear imaging findings discussed and reported.
