1What Is the C930 OHIP Code?
The C930 billing code is utilized by ophthalmologists providing consultations specifically focused on uveitis and other ocular inflammatory diseases for hospital in-patients. This service requires an in-depth assessment given the complexity and potential complications associated with these conditions. Common scenarios include cases such as endogenous endophthalmitis or ocular involvement of a systemic vasculitis, where specialized ophthalmic expertise is crucial for patient management.
Consultations under this code must follow a request from a qualified referring provider. This ensures that the service is warranted by the specificities and severity of the patient's condition, thus differentiating it from more general ophthalmological evaluations.
These consultations may often be overlooked by physicians unfamiliar with the specific billing codes or those who might incorrectly assume that related general codes cover the complexity of ocular inflammatory conditions. Proper application of C930 ensures accurate reimbursement for the level of expertise involved in these cases.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | Refer to frequency limits as per the specialist's assessment. | Used for consultations requiring surgical expertise beyond general ophthalmology. |
| C935 | Special surgical consultation | Refer to frequency limits as applicable, especially in surgical contexts. | Pertains to special surgical consultations within hospital settings. |
| A231 | Neuro-ophthalmology consultation | Subject to the same general frequency limits as C930. | Focused on neuro-ophthalmological issues possibly related to systemic conditions. |
| A235 | Consultation | General use, with broad application across patient assessments. | Covers general ophthalmology consultations, typically less specialized. |
3Eligibility Requirements
Eligibility Requirements for C930
- Setting: This code is for non-emergency hospital in-patient services as per the Ophthalmology listings.
- Frequency: Billing is limited to one service per two consecutive 12-month periods for the same patient, same physician, and same diagnosis. However, if an additional service is needed for the same diagnosis in a hospital in-patient setting or Emergency Department, and is conducted more than 12 but less than 24 months after the first, a second consultation is permitted within the same period.
- Unrelated Diagnosis: A consultation for a clearly defined unrelated diagnosis is limited to one service every 12 months.
- Consultation Requirements: Must follow a written request by a referring physician, nurse practitioner, or dental surgeon.
- Documentation: Maintain comprehensive documentation as required by General Preamble GP16, including a written report to the referring source.
For further details, see General Preamble GP40-48 and GP65-78.
4What Your Clinical Note Must Show
Ensure the following documentation requirements are met to avoid reductions in payable amounts.
- A written request for consultation from a referring provider must be on file.
- Consultation request must identify consultant, and referring provider's details.
- Include patient health number and relevant details for referral justification.
- Prepare a comprehensive report with findings, opinions, and recommendations.
- Record times when the insured service started and ended on the patient's chart.
5Weak vs. Strong Note Examples
The strong note succeeds because it includes detailed findings, the reason for referral, and precise documentation of start and end times, whereas the weak note lacks specificity and supporting details.
Consultation done. Seen patient with severe uveitis.
Consultation requested by Dr. Smith for assessment of uveitis.
Patient presents with severe ocular inflammation, diagnosed with endogenous endophthalmitis.
Conducted full ophthalmological assessment, findings include retinal swelling and anterior chamber exudates.
- Prepared detailed report on diagnostics, findings, and treatment recommendations.
- Started consultation at 10:00 AM and concluded at 11:00 AM.
