1What Is the C845 OHIP Code?
The C845 billing code represents a limited oncology consultation service for in-patients in Ontario. This code is utilized when an oncologist is consulted for a narrowly focused opinion on a specific oncological question. For instance, determining whether an incidental lesion requires staging or if chemotherapy is appropriate given a new patient complication.
This type of consultation typically involves a concentrated assessment rather than a comprehensive evaluation. It is crucial for clinicians to select between C845 and other consultation codes based on the actual service provided, as there can be confusion due to similar fees with the C446 repeat consultation code.
Ensuring the correct code is selected prevents discrepancies and potential claim rejections; thus, thorough documentation of the consultation’s limited scope is essential.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A445 | A445 Consultation | Medical Oncology listings | $183.40, full consultation service |
| A446 | A446 Repeat consultation | Medical Oncology listings | $115.95, equivalent to limited repeat consultation |
| A845 | A845 Limited consultation | Medical Oncology listings | $115.95, for out-patient limited consultations |
| C445 | C445 Consultation | Medical Oncology listings | $183.40, full consultation service |
3Eligibility Requirements
C845 may be billed for a limited oncology consultation provided to hospital in-patients and is payable under OHIP at a fee of CAD 115.95.
Virtual Delivery:
- C845 can be rendered virtually and billed as C845A, under the 'VIDEO ONLY' criteria. It is not eligible for telephone delivery.
Billing Frequency:
- One service per two consecutive 12-month periods for the same patient, physician, and diagnosis.
- One service every 12 months for clearly defined unrelated diagnoses.
Equivalent Code for Out-Patients:
- The corresponding out-patient code is A845, applicable for similar services rendered outside inpatient settings.
4What Your Clinical Note Must Show
Ensure comprehensive and specific documentation:
- Patient history and presenting complaint
- Specific oncological question addressed
- Consultation outcome and recommendations
- Date and setting of the service rendered
5Weak vs. Strong Note Examples
The strong note includes specific details about the clinical question and the recommendations given, while the weak note is vague and does not convey the scope or outcome of the consultation.
Consultation done. Discussed with team.
Patient presented with new CT findings suggesting an incidental lesion.
Consultation requested to determine if staging is necessary. Reviewed patient's medical history and current presentation.
Recommendations: Staging recommended based on identified factors.
- Clear description of the clinical question and need for consultation.
- Specific recommendations provided.
- Details enabling proper claim processing and follow-up.
