1What Is the C905 OHIP Code?
What is the C905 Billing Code?
The C905 code under OHIP allows family physicians to bill for a limited consultation. It represents the least demanding tier of consultations within a hospital setting, typically involving a single, focused question that does not require a full consultative assessment. For instance, a C905 may be used when a family physician is asked to confirm a patient's community medication list or previous workup without performing a comprehensive consultative evaluation.
Family physicians will often utilize the C905 code when their expertise is needed to answer a specific inquiry regarding an inpatient’s existing medical regimen or history. This type of consultation is more restricted in scope and time involvement compared to a comprehensive consultative service.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A914 | GP focused practice comprehensive consultation by Video | Once per 12-month period | A comprehensive consultation via video for intricate cases. |
| A006 | Repeat consultation | As needed for ongoing care | A follow-up consultation for continuing assessments. |
| A010 | GP focused practice consultation by Video | Once per differing diagnosis per 12 months | A focused consultation via video for tailored advice. |
| A011 | GP focused practice repeat consultation by Video | As needed for ongoing care | A follow-up video consultation to reassess treatments. |
3Eligibility Requirements
Eligibility Requirements for C905
For a service to qualify as a limited consultation under C905, certain criteria must be met:
- Referral is Essential: The consultation must be requested in writing by a referring physician, nurse practitioner, or dental surgeon in connection with an insured dental procedure rendered in a hospital. The request should be based on complexity, seriousness, or a need for another opinion.
- Nature of the Consultation: The service should specifically involve a limited assessment rather than a comprehensive one. It should answer a focused query and not entail the time investment and depth of a full consultation.
- Frequency Limitations: The limited consultation can be billed once per two consecutive 12-month periods for the same patient, physician, and diagnosis; however, separate consultations for distinct diagnoses can be billed once per 12 months.
4What Your Clinical Note Must Show
Ensure all necessary elements are captured for billing a limited consultation.
- A written request from the referring practitioner is included in the patient's chart.
- Clear documentation of the specific assessment and advice provided.
- Record of time spent on the consultation and any unique elements justifying the limited nature of the consult.
5Weak vs. Strong Note Examples
The strong note succeeds by providing detailed documentation of the consultation purpose, process, and outcome, while the weak note lacks specificity and depth.
Consulted by cardiology team regarding patient medication list. Provided advice.
Consulted by cardiology on Sept 1, 2023, regarding patient's community medication list.
Reviewed medical history and confirmed current prescriptions with patient and pharmacy, clarifying dosages and adherence.
- Advised on medication interactions.
- No changes recommended based on this focused assessment.
