1What Is the C745 OHIP Code?
What is the C745 Code?
The C745 OHIP billing code is used by radiation oncologists for limited consultations in non-emergency in-patient hospital settings. These consultations typically involve providing a concise expert opinion regarding the urgency and sequence of palliative radiotherapy for a patient, rather than conducting a comprehensive treatment-planning assessment.
This limited consultation is particularly beneficial in scenarios where patients require quick decisions or advice related to palliative care, making it a pivotal tool in hospital ward settings. The focus is on delivering essential insights with reduced demands on time compared to a full consultation.
Many practitioners might overlook using C745 if they aren't fully aware of its specific application in radiation oncology in-patient settings. Ensuring the correct coding can streamline reimbursement processes efficiently.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A345 | Consultation | No more than twice per diagnosis in two consecutive years | Full consultation for a new or different set of problems. |
| A346 | Repeat consultation | As medically necessary | When further assessment is required beyond the initial consultation. |
| A745 | Out-patient Limited consultation | Subject to the same frequency limits as in-patient | Limited consultation conducted outside of a hospital setting. |
| C345 | Consultation | Same frequency rules as A345 but in-patient | Full in-patient consultation for new or complex issues. |
3Eligibility Requirements
Eligibility Requirements for C745
- Setting: Must be a non-emergency in-patient service in a hospital.
- Virtual Delivery: Eligible for video consultation only; code it as C745A. Telephone consultations do not qualify.
- Consultation Requirements: A consultation must follow a written request from a referring physician, nurse practitioner, or dental surgeon related to a hospital dental procedure. The consultation is warranted due to the patient's complexity, seriousness, or at the patient or representative’s request.
- Frequency Limits: Limited to one service per two consecutive 12-month periods for the same patient, physician, and diagnosis; however, it can be twice if related to in-patient care more than 12 months apart. For unrelated diagnoses, bill once every 12 months.
4What Your Clinical Note Must Show
Ensure the following are documented for C745 billing:
- Written referral from the applicable healthcare provider.
- Details of the clinical findings and suggested actions related to the consultation.
- Notes on the consultation duration and relevance to palliative radiotherapy if applicable.
5Weak vs. Strong Note Examples
The strong note succeeds as it provides specific reasoning, referral details, and actionable outcomes, while the weak note lacks detail and context.
Patient referred for limited consultation. Provided opinion.
Consultation required for palliative radiotherapy urgency and sequencing. Patient referred by Dr. Smith. Recommendations were concise and focus pointed.
- Detailed patient history review.
- Discussion with referring physician regarding treatment options.
