1What Is the C945 OHIP Code?
A C945 billing code is used for a special palliative care consultation in the Ontario Health Insurance Plan (OHIP) system. This service is sought for patients needing specialized management in palliative care, often for individuals with advanced illnesses requiring symptom control and a comprehensive care plan.
Physicians in family practice render this service primarily to hospital in-patients. The service encompasses a thorough psychosocial assessment, pharmacotherapy review, and family counseling, with significant time dedicated to direct patient interaction. Due to its complexity, it cannot be billed concurrently with other consultations without meeting specific criteria.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A945 | Special palliative care consultation | Subject to same conditions as C945 | $174.25, similar usage but for outpatient settings |
| A914 | GP focused practice comprehensive consultation by Video | Specific criteria apply | $247.40, virtual format for focused practice |
| A005 | Consultation | Standard conditions | $95.60, general consultation service |
| A006 | Repeat consultation | Depends on conditions met | $47.10, for follow-up consultations |
| A010 | GP focused practice consultation by Video | Specific criteria apply | $95.60, virtual consultation |
3Eligibility Requirements
To bill C945 under OHIP, the physician must:
- Receive a written request from a referring physician, nurse practitioner, or dental surgeon.
- Spend at least 50 minutes in direct consultation with the patient and/or their family.
- Conduct a psychosocial assessment, pharmacotherapy review, and offer counseling.
- Record start and stop times for the service in the patient's permanent medical record.
Frequency of billing is limited to one service per two consecutive 12-month periods under most conditions. An exception allows for two such services within this period if rendered more than 12 months apart under specific circumstances (i.e., if the second instance occurs during inpatient hospitalization or in the Emergency Department).
4What Your Clinical Note Must Show
Ensure documentation aligns with OHIP requirements to avoid payment adjustments.
- Written request for consultation from a qualifying referrer.
- Record of start and stop times in patient's medical records.
- Comprehensive consultation notes, including psychosocial assessment and interventions.
5Weak vs. Strong Note Examples
The strong note succeeds due to detailed documentation of the consultation's breadth, time recording, and actionable outcomes, whereas the weak note lacks specificity and fails to capture the comprehensive nature of the service.
Met with patient and discussed care plan. Reviewed medications.
Conducted a comprehensive palliative care consultation with the patient and family. Discussed patient’s current symptoms, including advanced pain management strategies. Completed psychosocial assessment and comprehensive pharmacotherapy review. Counselled family on available community services.
- Start time: 10:00 AM, End time: 11:00 AM
- Patient expressed concerns about pain management; adjusted medication per new protocol
- Family provided with contact information for relevant local support groups
