1What Is the C925 OHIP Code?
A limited consultation under code C925 in the context of occupational medicine typically involves providing a short opinion regarding whether a hospital admission is work-related and what subsequent reporting obligations are triggered. This differs from a full consultation, which would require a comprehensive exposure assessment. Limited consultations are frequently missed or misbilled due to unclear referral requests or misinterpretation of the consultation's depth and breadth. It is crucial to ensure that the requirements for a limited consultation as outlined by OHIP are met to avoid incorrect billing.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A720 | Comprehensive occupational medicine consultation | A detailed assessment in occupational medicine. | |
| A725 | Consultation | General consultation service in occupational medicine. | |
| A726 | Repeat consultation | Repeat consultation in occupational medicine, limited occasions. | |
| A925 | Limited consultation | Limited consultation outside hospital settings in occupational medicine. |
3Eligibility Requirements
Eligibility for billing C925 requires that the consultation be performed in a non-emergency hospital in-patient setting in the field of occupational medicine. The consultation must follow a written request from a referring physician, nurse practitioner, or dental surgeon if related to an insured dental procedure. C925 can also be billed as a virtual service (C925A) when rendered via video, but it is not eligible for billing if conducted by telephone. The consultation frequency is limited to one service per two consecutive 12-month periods for the same patient, physician, and diagnosis, unless a clearly defined unrelated diagnosis is presented.
4What Your Clinical Note Must Show
A consultation is an assessment following a written request from a referring physician, nurse practitioner, or dental surgeon.
- Request must be written and from a qualified professional.
- Consultation must occur in a non-emergency hospital in-patient setting.
- Service must meet OHIP's consultation criteria.
5Weak vs. Strong Note Examples
The strong note succeeds by demonstrating detail-oriented assessment and interaction with the referring physician, covering specific work-related concerns. The weak note fails to document specific evaluation criteria crucial for validating the billing of a limited consultation.
Consulted patient about their current job. No additional occupational-related questions were asked or tests ordered. Patient feels their condition is job-related, no further assessment required.
Reviewed patient history focusing on potential work-related injury.
Collaborated with the referring physician to assess possible job-related causes.
Recommendations provided for work adaptations based on findings.
- Received a detailed referral note from primary physician.
- Assessed patient's specific job tasks and potential exposures.
- Documented all findings with recommendations for follow-up.
