1What Is the C795 OHIP Code?
Overview of C795
C795 is the billing code for geriatric psychiatric consultations under Ontario's OHIP system. This code applies primarily to complex consultations where a geriatric psychiatrist assesses an older adult patient in a hospital setting. The objective is to address intricate psychiatric conditions, including overlapping issues like delirium, undiagnosed dementia, and primary psychiatric illnesses.
This code is frequently overlooked in outpatient settings, where A795 is applicable. C795 demands a comprehensive assessment and is specifically tailored to meet the needs of elderly patients who may have a multifaceted psychiatric presentation.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A795 | A795 Geriatric psychiatric consultation | office and clinic equivalent | Used outside hospital settings with the same conditions as C795. |
| A190 | A190 Special psychiatric consultation | Not specified | A comprehensive psychiatric consultation at the same fee. |
| A195 | A195 Consultation | Not specified | Standard consultation in psychiatry. |
| A196 | A196 Repeat consultation | Not specified | Used for a return visit. |
3Eligibility Requirements
Eligibility for C795 Billing
To qualify for C795 billing, the following criteria must be met:
- Setting: The initial consultation must be rendered to a hospital inpatient or a patient in the Emergency Department.
- Frequency: One service per two consecutive 12-month periods for the same patient, physician, and diagnosis. Though, a second service may be billed for inpatients more than 12 but less than 24 months after the first consultation.
- Virtual Care: C795 can be billed as C795A for video consultations only, not telephone.
In cases of clearly defined unrelated diagnoses, one service per 12 months is allowed, with additional services excess being paid at general or specific assessment rates.
4What Your Clinical Note Must Show
Ensure to document the following when billing C795:
- Comprehensive consultation details involving a minimum of 75 minutes in direct contact.
- Patient history and examination with distinct reference to the geriatric psychiatric condition.
- Exclusion of non-patient-facing activities like chart review.
- Justification for choosing C795 over a general assessment.
5Weak vs. Strong Note Examples
The strong note clearly captures the comprehensive assessment and includes detailed collateral interactions, while the weak note lacks specificity and depth.
Patient seen for evaluation.
Discussed care with family.
Comprehensive evaluation conducted over 80 minutes detailing symptoms of confusion and aggression.
Collateral family history obtained, indicating possible underlying dementia.
Discussed coordinated discharge planning with ward nursing staff.
- Included assessment of medication impacts.
- Differentiated between psychiatric and medical causes.
