1What Is the C800 OHIP Code?
C800 is an Ontario Health Insurance Plan (OHIP) billing code for genetic assessments requested by midwives or aboriginal midwives for hospitalized patients. These assessments are performed by a geneticist in response to complex, obscure, or serious clinical findings during antepartum or postpartum periods.
The use of this code typically arises following abnormal prenatal results or unexpected findings in a newborn, emphasizing the importance of specialized genetic insights. Despite these clinical needs, the code can be overlooked due to the specificity of its application criteria and the busy nature of patient care settings.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A800 | Midwife or Aboriginal Midwife-requested genetic assessment | Governed by the special listing and General Preamble assessment rules | Equivalent service rendered outside of hospital in-patient settings. |
| A220 | Special genetic consultation | Subject to specific or special rules as noted in the Genetics (22) listing | A comprehensive consultation involving detailed assessment by a geneticist. |
| A223 | Extended special genetic consultation | Subject to specific or special rules as noted in the Genetics (22) listing | An in-depth consultation exceeding typical genetic assessments. |
| A225 | Consultation | Subject to arrangement and agreement between physician and ministry | General geneticist consultation without midwife initiation. |
| A226 | Repeat consultation | Subject to the same schedule rules as an initial consultation | Follow-up consultations for ongoing cases. |
3Eligibility Requirements
C800 Eligibility Requirements
C800 is the same service as A800, rendered to a hospital in-patient (non-emergency hospital in-patient services - see General Preamble GP40 to GP48). Outside hospital in-patient settings, bill A800.
- Who requests it: a midwife or Aboriginal midwife, in writing, because of the complex, obscure or serious nature of the patient's problem. An urgent request may start verbally but must be put in writing.
- What the service includes: the common and specific elements of an assessment. The Schedule sets no minimum duration for C800, and no start-and-stop-time entry is required. The 75-minute and 90-minute requirements belong to the comprehensive and extended tiers, which are separate codes.
- Frequency: one per patient, per physician, per 24 month period.
- Written report: findings, opinions and recommendations must go in writing to both the midwife or Aboriginal midwife and the patient's primary care physician or nurse practitioner, if applicable, or the amount payable is reduced to a lesser fee.
- Medical record: the written request must be retained on the patient's permanent medical record, or the amount payable is reduced to a lesser fee.
4What Your Clinical Note Must Show
Two documents decide whether C800 is paid in full:
- The midwife's or Aboriginal midwife's written request, retained on the patient's permanent medical record.
- The written report of findings, opinions and recommendations, sent to both the midwife and the patient's primary care physician or nurse practitioner, if applicable.
- No start-and-stop-time entry is required for C800; that requirement belongs to the comprehensive tier.
5Weak vs. Strong Note Examples
The strong note succeeds because it includes specific documentation of the time spent, maintains a formal written report, and ensures adherence to billing requirements. The weak note lacks time documentation and fails to provide necessary written communication, risking a fee reduction.
Consultation performed on in-patient. Findings given verbally to the midwife.
Neither the written request nor a written report is on file, and those are the two conditions of payment.
Genetic assessment of an admitted patient at the written request of midwife J. Smith (request filed on the permanent record), following an abnormal prenatal screening result.
History, examination and risk discussion completed on the ward; written findings and recommendations sent to the midwife and to the patient's family physician.
- Patient is a hospital in-patient, which is what makes C800 rather than A800 the correct code.
- Written request from the midwife retained on the permanent medical record.
- Report sent to both the midwife and the primary care physician.
- Duration not asserted - C800 carries no minimum time requirement.
