1What Is the C865 OHIP Code?
What is the C865 Limited Consultation Code?
The C865 code is used by nephrologists for limited consultations on non-emergency hospital in-patients in Ontario. It applies when a concise opinion is required, such as assessing electrolyte or fluid-balance issues, without necessitating a full renal assessment.
This code reflects a consultation that is less demanding in terms of time compared to comprehensive consultations, such as A160 or A165. Often, it is utilized in cases where the primary ward team seeks specific input from a nephrologist to manage particular concerns efficiently.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A160 | Comprehensive nephrology consultation | Subject to consultation limits. | Used for more extensive nephrology assessments than the limited consultation. |
| A165 | Consultation | Subject to consultation limits. | A standard consultation option for nephrology, more comprehensive than a limited consultation. |
| A166 | Repeat consultation | Subject to repeat limits. | Used for follow-up consultations when complexity warrants. |
| A865 | Limited consultation | For out-patient settings. | Same service as C865, but for out-patient settings. |
3Eligibility Requirements
Eligibility Criteria for C865 Billing
- Setting: Non-emergency in-patient hospital services.
- Referral Requirements: Must occur following a written request from a referring physician, nurse practitioner, or dental surgeon associated with an insured hospital procedure.
- Frequency Limits: Maximum of one service per two consecutive 12-month periods for the same patient and diagnosis. If unrelated diagnoses are treated, one service is allowed every 12 months.
- Virtual Service: Eligible for virtual billing as C865A via video only; telephone services are not covered under this code for virtual care.
4What Your Clinical Note Must Show
Ensure all consultations are clearly documented, with specific details of the referral and assessment provided.
- Referral source and details, including written request documentation.
- Patient assessment focused on specific renal issues like electrolytes or fluid balance.
- Consultation summary and clinical opinion rendered to the referring team.
5Weak vs. Strong Note Examples
The strong note succeeds by providing comprehensive documentation of the referral, diagnostic focus, and clinical recommendations, meeting the requirements for a limited consultation. The weak note lacks specificity and detail.
Patient referred for fluid balance issue. Opinion given.
Patient referred by Dr. Smith for fluid imbalance management. Assessment focused on acute hyponatremia due to SIADH. Reviewed lab results and offered management recommendations.
- Documented referral source.
- Specific patient condition addressed.
- Detail on the assessment and management recommendations.
