1What Is the C912 OHIP Code?
The C912 OHIP billing code is used for comprehensive consultations in family and general practice, particularly for hospital in-patients. These consultations are extensive assessments requiring a minimum of 75 minutes of direct contact, providing a deep evaluation of the patient’s medical conditions, functional status, and discharge planning. This is crucial in complex cases involving elderly patients with multiple chronic conditions and an unclear prognosis.
Such consultations are integral when the ward team needs a comprehensive understanding of a patient’s health, including their support systems and capacity for discharge. It's a service that demands significant time investment and detailed assessment, differentiating it from regular consultations due to the complexity and thoroughness required.
This billing code might be overlooked when physicians consider the time spent discussing potential interventions or planning beyond simple chart reviews, leading to underutilization.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A912 | Comprehensive family and general practice consultation | One service per two consecutive 12-month periods | Equivalent service rendered outside hospital in-patient settings. |
| A914 | GP focused practice comprehensive consultation by Video | Same frequency restrictions as C912 | Comprehensive consultation performed via video. |
| A005 | Consultation | Limitations apply | General consultation service. |
| A006 | Repeat consultation | No specific frequency limits | Consultation follow-up or repeat visit. |
3Eligibility Requirements
To bill under the C912 code, the following eligibility requirements must be met:
- Written Request: The consultation must follow a written request from a referring physician, nurse practitioner, or dental surgeon who requires the consultant's opinion because of the complexity or seriousness of the case.
- Direct Patient Contact: The service requires at least 75 minutes of direct patient contact.
- Documentation: Start and stop times of the consultation must be recorded in the patient's permanent medical record.
- Service Frequency: Consultations are limited to one service per two consecutive 12-month periods for the same patient, the same physician, and the same diagnosis. Exceptions include hospital inpatient settings and clearly defined unrelated diagnoses. Excess services are adjusted to lesser paying rates.
- Exclusivity of Service: No other consultation, assessment, or counseling service is payable on the same day by the same physician for the same patient.
Ensure compliance with these requirements to optimize reimbursements under the C912 billing code.
4What Your Clinical Note Must Show
Record the actual start and stop times of the consultation in the patient's permanent medical record to ensure proper billing.
- The recorded time is crucial for maintaining the validity of the 75-minute requirement.
- Omissions can lead to downcoding of the service fee.
Maintain a copy of the request for consultation in the patient's file, including all necessary identifiers and information.
- The request must detail the referring professional and the reason for the consultation.
- Include all relevant patient identification and health information numbers.
Draft a comprehensive report for the referring physician, nurse practitioner, or dental surgeon promptly after the consultation.
- The report should include findings, professional opinions, and any recommendations.
- Ensure the report is shared with the referral source and kept in the patient’s medical record.
5Weak vs. Strong Note Examples
Consultation conducted with Mr. Smith. Discussed health concerns.
Conducted a comprehensive 85-minute consultation with Mr. John Smith, as per Dr. Jane Doe’s request for evaluation due to Mr. Smith's complex chronic conditions.
Assessment included a full review of medication, functional assessments, support systems, and discharge planning recommendations.
- Start time: 10:00 AM
- End time: 11:25 AM
