1What Is the C815 OHIP Code?
What is C815?
C815 is an OHIP billing code designated for special assessments requested by a midwife or Aboriginal midwife for obstetrical or newborn patients in a hospital in-patient setting. This assessment is typically necessary when complications arise during a midwife-attended hospital birth. Physicians may be called upon to perform critical evaluations in cases such as failure to progress, postpartum hemorrhage, or when newborns require pediatric assessments.
Commonly missed criteria include ensuring that the request originates from a midwife or Aboriginal midwife and understanding that this is a special assessment, not a consultation. Physicians-initiated opinions fall into different billing categories under consultation codes.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A815 | Midwife or Aboriginal Midwife-Requested Special Assessment | As governed by the general assessment rules. | The outpatient equivalent to C815, applicable outside hospital in-patient settings. |
| A914 | GP focused practice comprehensive consultation by Video | As specified in Family Practice listings. | A comprehensive video consultation service in family practice. |
| A006 | Repeat consultation | As specified in Family Practice listings. | A repeat consultation in a general practice setting. |
| A010 | GP focused practice consultation by Video | As specified in Family Practice listings. | A focused consultation conducted via video in family practice. |
3Eligibility Requirements
Eligibility for C815
According to the OHIP Schedule of Benefits, C815 applies to special assessments conducted at the request of a midwife or Aboriginal midwife for hospital in-patient settings. The equivalent code for outpatient services is A815. It's crucial for the requesting party to be a midwife, and the code pertains strictly to assessments, not consultations. Familiarize yourself with the relevant General Preamble assessment rules to avoid billing errors. There is no fixed annual cap for billing frequency; however, examine specific rules for any per-day or per-patient limits.
4What Your Clinical Note Must Show
Maintain thorough records documenting the midwife's request and the specific medical need for the assessment.
- Midwife or Aboriginal midwife's written request.
- Detailed patient assessment notes.
- Description of any complications encountered.
- Follow-up care instructions given.
5Weak vs. Strong Note Examples
The strong note clearly documents the reason for the assessment, the process undertaken, and subsequent medical decisions, whereas the weak note lacks specificity and fails to illustrate the complexity of the case.
Assessed patient as requested by midwife. Completed examination.
Assessment requested by Aboriginal midwife due to complication: postpartum hemorrhage.
Conducted full obstetrical assessment.
- Assessment results indicate need for further intervention.
- Follow-up plan: ultrasound scheduled.
