1What Is the C911 OHIP Code?
C911 is an OHIP billing code used for special consultations conducted by family physicians for hospital inpatients. These consultations involve at least 50 minutes of direct patient contact to address complex cases that require comprehensive evaluation, often involving multiple chronic issues.
This code is typically utilized when the hospital ward team requires an in-depth consultation that extends beyond a focused opinion. For example, a patient experiencing functional decline due to interacting cardiac, cognitive, and medication factors may necessitate such in-depth review.
Missing the opportunity to bill under C911 may occur if the consultation details, such as time spent or the consulting nature of the visit, are not adequately documented, or if requirements like the written request are not met.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A911 | Special family and general practice consultation | Same as C911 | Subject to the same conditions and fee as C911, but outside hospital in-patient settings. |
| A914 | GP focused practice comprehensive consultation by Video | Not specified | Comprehensive video consultations for focused practice by GPs. |
| A005 | Consultation | Not specified | General family and practice consultation code. |
| A006 | Repeat consultation | As needed | Subsequent consultations following an initial consultation. |
3Eligibility Requirements
C911 is to be used for consultations conducted by family physicians under the following criteria:
- The consultation involves a minimum of 50 minutes of direct patient contact.
- The service must follow a written request from a referring provider, which can be a physician, nurse practitioner, or dental surgeon, highlighting the complexity or obscurity of the case.
- Documentation including start and stop times must be recorded in the patient's medical record.
- The consultation is typically limited to one service per two consecutive 12-month periods for the same patient and diagnosis, with specific exceptions allowing for a second service in certain inpatient or emergency settings.
- Consultations for a clearly defined unrelated diagnosis are eligible for billing once every 12 months.
- Services exceeding these frequencies may be adjusted to a lesser fee.
4What Your Clinical Note Must Show
Ensure all elements of a consultation are documented.
- Record the start and stop times in the patient's record.
- Include a written request from the referring provider.
The consultation must be based on a documented request.
- The referral must be signed by the referring provider.
- Include the names and billing numbers of the consultant and referring provider.
- Detail the patient's name and health number.
- Specify the services required and relevant information for the referral.
5Weak vs. Strong Note Examples
The strong note includes all required elements: exact time of service, specific details about patient issues, and a clear reference to the documented request and follow-up plan.
Consulted with patient regarding ongoing health issues. Discussed various concerns over approximately 50-minute call.
Conducted special consultation, referred by Dr. Smith (referring physician's billing number: 12345) for complex case management.
- Direct patient contact from 10:00 am to 10:50 am.
- Discussion focused on chronic cardiac and cognitive issues related to patient's reported functional decline.
- Detailed recommendations provided to the referring physician in the comprehensive report.
