C193 – Psychiatric consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A specific assessment rendered by a psychiatrist for a non-emergency acute care hospital in-patient. The 'C' prefix designates this service for non-emergency in-patient settings as per . As defined in , this service requires a full history of the presenting complaint and detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis, and/or exclude disease, and/or assess function. In addition to the common elements of all insured services (, ), this service includes the specific elements of assessments outlined in , which include: a direct physical encounter, taking a patient history, performing a physical examination, making arrangements for related care, and providing advice to the patient or their representative.
When to Use
- Use C193 for a non-emergency, scheduled psychiatric assessment of an admitted hospital in-patient where a comprehensive history and mental status examination are required.
- Use C193 when performing a formal psychiatric consultation for a patient admitted to a medical or surgical ward, provided the service is not urgent and does not qualify for Special Visit Premiums.
Common Pitfalls
- Billing C193 in conjunction with Special Visit Premiums (e.g., K963, K965) will result in a rejection, as C-prefix codes are explicitly excluded from these premiums per A172.
- Exceeding the limit of one C193 per patient per 12-month period without documenting a distinct, unrelated diagnosis will trigger an automatic payment adjustment to a lower assessment fee.
- Confusing C193 with A193; A193 must be used if the psychiatric assessment is performed as an emergency or requires a Special Visit Premium.
Billing Tips
- If the patient is located in an ICU or CCU, ensure you append the C101 premium to C193 to capture the additional intensity of the setting.
- Always document the specific mental status examination components and the psychiatric history to satisfy the 'detailed examination' requirement mandated by GP15 and GP23.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
In addition to standard medical record requirements, the record must document the specific elements of an assessment, including a full history of the presenting complaint and a detailed examination of the affected part(s), region(s), or system(s).
This code is for non-emergency hospital services. For emergency calls and other special visits to in-patients, use General Listings ('A' prefix codes) and Premiums when applicable.
See General Preamble to for terms and conditions for non-emergency hospital services.
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