1What Is the C775 OHIP Code?
A comprehensive geriatric consultation under code C775 is a detailed assessment conducted by a physician with a special competence in geriatrics for patients at least 65 years old or for the assessment of dementia. This consultation requires the physician to spend at least 75 minutes in direct contact with the patient, ensuring a thorough evaluation of their cognitive, functional, and medication needs.
In hospital in-patient settings, such consultations are crucial for discharge planning and care management of older adults who are admitted acutely. Due to its complexity and comprehensive approach, this service seeks to address various geriatric syndromes that might not be evident through standard consultations.
This code is often underutilized due to the extensive documentation required, including detailed time recording and the necessity for a written consultation request from the referring physician. These administrative details can sometimes lead to missed billing opportunities for eligible services.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A775 | Comprehensive geriatric consultation | One service per two consecutive 12-month periods | Equivalent service outside hospital settings billed under C775. |
| A070 | Consultation in association with special visit to a hospital | Determined by special visit rules | Consultation services during special hospital visits. |
| A075 | Consultation | Unlimited | Standard geriatric consultation service. |
| A076 | Repeat consultation | Unlimited as needed | Applicable for follow-up within specialty. |
| A375 | Limited consultation | Unlimited as needed | Less comprehensive initial consultation. |
3Eligibility Requirements
To bill the C775 code, the following eligibility criteria must be met:
- The patient must be at least 65 years old, or the consultation must be specifically for dementia assessment.
- The service must include a minimum of 75 minutes of direct patient contact, excluding time spent on any other separately billable interventions.
- A written consultation request from a referring physician, nurse practitioner, or dental surgeon must be present, specifying the need for geriatric assessment.
- The consultation must not have been rendered on the same patient by the same consultant within the last 2 years, except for specified scenarios involving hospital inpatients or Emergency Department patients.
It is essential that all consultation services record the start and stop times in the patient's permanent medical record.
4What Your Clinical Note Must Show
Essential for C775 billing compliance.
- Record start and end times of consultation in medical records.
- Ensure a written request from the referring physician is present.
- Maintain a copy of the consultation report sent to the referring physician.
5Weak vs. Strong Note Examples
The strong note succeeds because it includes specific times, names the referring physician, and confirms the preparation of a detailed report, while the weak note lacks these details.
Consultation completed for dementia assessment.
Comprehensive geriatric consultation conducted for dementia assessment as requested by Dr. Smith. Consultation started at 10:00 AM and ended at 11:30 AM. A detailed report was prepared and sent to the referring physician.
- Start and stop times recorded in the patient's medical record.
- Written request present from Dr. Smith for a dementia assessment.
