C220 – Special genetic consultation - non-emergency hospital in-patient
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A special genetic consultation provided for a non-emergency hospital in-patient. The 'C' prefix designates this service for acute care hospital non-emergency in-patient settings, as outlined in and . This service is subject to the same conditions as A220. As a consultation, it requires a written request from a referring physician, nurse practitioner, or dental surgeon in connection with an insured dental procedure in a hospital (). A copy of the written request must be maintained in the patient's medical record.
When to Use
- Use C220 for a formal, non-emergency genetic consultation requested by a referring physician for an inpatient in an acute care hospital setting.
- Use this code when the patient requires a specialized genetic evaluation that falls outside the scope of routine K016 genetic assessments or K222 genetic care.
Common Pitfalls
- Claiming C220 after having previously billed K016 or K222 for the same patient will result in a nil payment.
- Failure to document exact start and stop times in the medical record is a frequent cause of audit recovery for this code.
- Submitting C220 without a written referral request from a physician, nurse practitioner, or dental surgeon on file will result in a downgrade to a lower assessment fee.
Billing Tips
- Ensure the written referral request explicitly states the clinical question or service required, as vague requests may not satisfy the audit requirements for a formal consultation.
- Always verify if the patient qualifies for an age-based premium (e.g., AGE_PREMIUM_LT1Y) to maximize the claim value, as these are not automatically applied.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
A copy of the written request for the consultation, signed by the referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician's medical record. In a hospital where common medical records are maintained, the written request may be on the common record.
The request must identify the consultant by name, the referring practitioner by name and billing number, and the patient by name and health number.
The written request must set out the information relevant to the referral and specifies the service(s) required.
The service is eligible for payment only if start and stop times of the service are recorded in the patient's permanent medical record.
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