1What Is the C935 OHIP Code?
The C935 billing code applies to special surgical consultations provided by orthopaedic surgeons. These consultations are reserved for complex cases that require a detailed and comprehensive evaluation, typically not addressed in regular consultations. For orthopaedics, examples include consultations for severe trauma patients or those with prosthetic joint infections requiring intricate surgical planning.
It's important to dedicate at least 50 minutes of direct patient interaction, which distinguishes it from standard consultations. Ensuring the minimum time requirement and complexity justifies this enhanced billing to warrant the higher reimbursement rate.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | Once per 12 months, or two per 24 months with specific conditions | Out-patient equivalent of C935. |
| A065 | Consultation | Standard consultation, general billing rules apply | Regular consultation in orthopaedics. |
| A066 | Repeat consultation | Follow-up consultation when clinically necessary | Used for subsequent necessary consultations within orthopaedics. |
| C065 | Consultation | Standard consultation, per patient need | General orthopaedic consultation, in-patient setting. |
3Eligibility Requirements
To be eligible for billing under C935, physicians must render a special surgical consultation where they engage in all elements of a regular consultation but extend the interaction to a minimum of 50 minutes with the patient. This code must be utilized in orthopaedic settings such as in-patient hospital services, and it is intended for complex cases that demand detailed examination and discussion beyond a standard consultation. C935 can be billed once per two consecutive 12-month periods unless the second consultation in such a period meets specific criteria, allowing two billings. The code can also be billed virtually, noted as C935A, but only through video consultations.
4What Your Clinical Note Must Show
Ensure your documentation meets the following criteria for C935 billing:
- Detail the orthopaedic complexity justifying a special consultation.
- Include time-stamped records indicating direct patient interaction beyond 50 minutes.
- Document the comprehensive elements discussed, including surgical options and strategies.
5Weak vs. Strong Note Examples
The strong note succeeds by providing a clear timeline, specific details about the surgical planning, and evidence of patient engagement, meeting the criteria for a special consultation.
Consulted with the patient about surgery. Requires follow-up.
Conducted a detailed consultation for 55 minutes discussing periarticular fracture reconstruction options. Evaluated patient's overall health status and aligned surgical plan with available treatment options.
- Discussed staging and weight-bearing implications
- Reviewed and explained prosthetic joint revision strategies
- Patient and family actively involved in the planning process
