1What Is the C915 OHIP Code?
What is C915?
C915 is an OHIP billing code used for limited consultations in the critical care specialty. This service involves a concise assessment that typically focuses on a specific issue, such as determining the appropriateness of care levels, addressing single-organ support considerations, or evaluating the need for intensive care unit transfer.
Limited consultations are less demanding and require significantly less time than full consultations, creating value by efficiently resolving critical questions. However, they often get overlooked because physicians assume a more comprehensive code might better remunerate their time, misunderstanding usage constraints.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A116 | Repeat consultation | As needed when criteria meet repeat consultation standards. | Applicable for subsequent consultations when reassessment of the same condition is necessary. |
| A710 | Comprehensive critical care medicine consultation | When complex full assessments are required. | Used for detailed critical care evaluations involving comprehensive assessments. |
| A715 | Consultation | When a standard comprehensive consultation is appropriate. | Used for full consultations that are more comprehensive than a limited scope. |
| A915 | Limited consultation (Outpatient) | Same frequency limits but applied in outpatient settings. | Equivalent code used for limited consultations outside hospital in-patient scenarios. |
3Eligibility Requirements
Eligibility Requirements
- Setting: Applicable to non-emergency hospital in-patient services in the Critical Care Medicine category.
- Consultation Type: Must originate from a written request by a referring physician, nurse practitioner, or dental surgeon for advice due to case complexity or patient request.
- Frequency Limits: Limited to one service for the same patient, physician, and diagnosis every two consecutive 12-month periods, or to one service every 12 months for a clearly defined unrelated diagnosis.
- Virtual Delivery: Can be rendered virtually via video, billed as C915A. Telephone consultations are not eligible under this code.
4What Your Clinical Note Must Show
Ensure thorough documentation of the following for billing C915:
- Written request from referring physician, nurse practitioner, or dental surgeon.
- Clearly defined consultation purpose and context.
- Assessment details demonstrating the specific issue addressed.
5Weak vs. Strong Note Examples
The strong note succeeds because it includes specific references to the consultation purpose, documentation of the referring request, and detailed assessment results that are aligned with the OHIP requirements.
This note lacks specifics and fails to comply with OHIP documentation standards.
Saw patient for quick assessment. Offered advice.
Detailed and compliant with C915 requirements:
Received request from Dr. Smith for evaluation of organ support necessity.
Assessed patient for potential ICU transfer. Recommended maintaining current care level.
- Specific referring party request cited.
- Clearly defined the assessment scope and findings.
