1What Is the H065 OHIP Code?
The H065 billing code is used for consultations in emergency medicine conducted by family physicians who are not certified as emergency medicine specialists. This consultation occurs when another physician requests a family physician to evaluate a patient in the emergency department. These consultations are critical for collaborative patient care and ensure comprehensive treatment plans are developed in complex emergency situations.
It's important to note that the H065 code differs from H055, which is reserved for certified emergency medicine specialists. Commonly, this code may be missed due to misunderstandings about the billing eligibility or overlap with similar codes like general assessments. Understanding and implementing this billing code ensures appropriate compensation for emergency medicine services provided in non-specialty settings.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A914 | GP focused practice comprehensive consultation by Video | Variable based on necessity and provider specialization | Provides comprehensive consultations remotely for family practice, applicable when video consultations are conducted. |
| A006 | Repeat consultation | As necessary within scope of practice and clinical context | Used for subsequent consultations; generally after an initial assessment has been completed. |
| A010 | GP focused practice consultation by Video | Variable based on necessity and provider specialization | Used for consultations by video link, offering flexibility in delivering patient care. |
| A011 | GP focused practice repeat consultation by Video | Variable based on recurrence and patient needs | Used for additional consultations in a remote setting. |
3Eligibility Requirements
The H065 billing code is eligible for use by family physicians conducting a consultation in emergency medicine at the request of another physician. There are specific conditions under which this code can be billed:
- One service per two consecutive 12-month periods can be billed for the same patient, same physician, and same diagnosis.
- Exceptions allow for two services per two consecutive 12-month periods if the second service is rendered to a hospital inpatient or emergency department patient more than 12 but less than 24 months after the first.
- If the diagnosis is clearly defined as unrelated, one service may be billed every 12 months.
- Any consultations exceeding these limits are reimbursed at the general or specific assessment rate.
4What Your Clinical Note Must Show
Ensure complete documentation of the consultation to meet OHIP billing requirements.
- Referral request from another physician
- Consultation notes including clinical findings and recommendations
- Patient's full medical history relevant to the consultation
Additional documentation is required when billing for a second service rendered more than 12 but less than 24 months after the first.
- Clear documentation showing the consultation setting (inpatient or emergency)
- Evidence of different episodes or unrelated diagnoses if applicable
5Weak vs. Strong Note Examples
The strong note clearly documents the clinical process and rationale, providing justification for the consultation, while the weak note lacks specificity and detail.
Consulted on patient's status. Advised further tests. Recommend follow-up.
Patient referred by Dr. Smith for consultation in emergency department for acute respiratory distress.
Thorough examination conducted, revealing signs of pneumonia. Recommended blood tests and chest X-ray. Tightened management plan including antibiotics.
Follow-up advice given, and discussed case findings with Dr. Smith.
- Comprehensive patient evaluation
- Clear documentation of clinical decision-making
- Collaboration with the referring physician
