1What Is the C895 OHIP Code?
C895 is a billing code under OHIP for consultations conducted by psychiatrists specifically for hospital in-patients. It is most commonly used in scenarios where a psychiatrist is called to assess situations of acute urgency, like severe agitation, suicide attempts, or capacity assessments that are critical to treatment decisions. This code is distinct for covering the consultative service itself, and it is important to recognize that the special visit premium should be claimed separately when applicable.
Misunderstandings around the application of C895 often arise due to its specific requirements and setting. It is designed for use in hospital situations, meaning it cannot be used for out-patient or office consultations unless the corresponding code A895 is used. It is crucial to note that while C895 can be rendered virtually, it must be conducted via video; telephone consultations do not qualify.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A190 | Special psychiatric consultation | Frequency based on clinical need and OHIP guidelines | A premium consultation for particularly complex psychiatric cases. |
| A195 | Consultation | One per 12-month period, related to different diagnoses | A standard consultation for psychiatric evaluation. |
| A196 | Repeat consultation | Based on follow-up needs, frequency determined by OHIP guidelines | For follow-up consultations after the initial evaluation. |
| A395 | Limited consultation | Dependent on need and patient situation | A shorter, more focused consultation. |
3Eligibility Requirements
C895 is eligible for billing under specific conditions:
-
It is limited to one service per two consecutive 12-month periods for the same patient, physician, and diagnosis. However, if a second consultation occurs within 12 to 24 months after the first and is for a hospital in-patient or in an emergency department, it can be billed. If the consultation is for a clearly unrelated diagnosis, one service is allowed every 12 months.
-
Virtual delivery is allowed, but only via video; telephone consultations are not eligible under C895.
-
This code is specific to psychiatric consultations in in-patient settings. For consultations conducted outside of these contexts, utilize A895 instead.
4What Your Clinical Note Must Show
The following items should be included in the medical record for C895 claims:
- Patient's presenting problems and history
- Consultation notes reflecting assessment and clinical findings
- Treatment decisions or recommendations
- Confirmation of in-hospital setting and urgency of the situation
- If virtual, confirmation of video mode of delivery
5Weak vs. Strong Note Examples
The strong note succeeds because it provides specific details about the patient’s condition, assessment, and the psychiatrist’s recommendations, thus supporting the need for the billed service. The weak note lacks specificity and fails to justify the service provided.
Consulted for patient in hospital. Discussed issues.
Patient presented in acute distress due to severe agitation. Conducted full psychiatric evaluation to assess risk of harm to self and others, confirming necessity for immediate intervention.
Recommendations for emergency medication adjustment and ongoing monitoring conveyed to staff.
- Outlined urgent patient condition
- Detailed nature of assessment and findings
- Recorded specific treatment recommendations
