C194 – Psychiatric consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A specific re-assessment is a service rendered by a specialist in Psychiatry for a non-emergency acute care hospital in-patient. It requires a full, relevant history of the presenting complaint and a 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 (, ). As per , this assessment includes the following specific elements: - A direct physical encounter with the patient including history taking and physical examination. - Inquiry carried out to arrive at an opinion as to the nature of the patient’s condition. - Performing any procedures during the same encounter unless separately listed in the Schedule. - Making arrangements for any related assessments, procedures or therapy, and/or interpreting results. - Making arrangements for follow-up care. - Discussion with, and providing advice and information to the patient or patient's representative. - Monitoring the patient's condition and intervening, when medically indicated, until the next insured service. This service is for an acute care hospital non-emergency in-patient, as indicated by the 'C' prefix ().
When to Use
- Use C194 for a subsequent psychiatric re-assessment of an admitted patient in an acute care hospital who is already under your care.
- Use C194 when performing a formal psychiatric re-evaluation of an inpatient for a new or evolving psychiatric concern that does not meet the criteria for a full consultation (C192).
- Use C194 for the admission assessment if you previously assessed the patient for the same illness prior to their hospital admission.
Common Pitfalls
- Do not bill C194 for patients seen in the Emergency Department; use the 'A' prefix codes from the General Listings for all ED encounters.
- Avoid billing C194 in conjunction with special visit premiums, as these are strictly prohibited for 'C' prefix services.
- Do not use C194 for a consultation request; use C192 for the initial formal consultation requested by another physician.
Billing Tips
- Ensure the documentation clearly reflects a full, relevant history and a detailed mental status examination to support the specific re-assessment requirements.
- If you are called to the hospital for an urgent or emergency assessment, bill the appropriate 'A' prefix code with the applicable special visit premium instead of C194.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
As outlined on page , admission assessments are deemed to be a specific re-assessment or medical specific re-assessment under either of the following circumstances: 1. for those procedures prefixed with a “Z” or noted as an IOP, by a surgical specialist who has assessed the patient prior to admission in respect of the same illness; or 2. for those patients who have been assessed by a physician and subsequently admitted to the hospital for the same illness by the same physician.
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