C400 – Comprehensive community medicine consultation (hospital in-patient)
OHIP Surgical Procedures Code — NON-EMERGENCY HOSPITAL IN-PATIENT SERVICES · Schedule of Benefits
A comprehensive community medicine consultation provided to a non-emergency hospital in-patient. This service is rendered by a specialist in community medicine and requires providing all appropriate elements of a consultation, with a minimum of seventy-five (75) minutes of direct contact with the patient. This time is exclusive of any other separately billable interventions. This service is subject to the same conditions as A400. As per , a consultation requires a written request from a referring physician, nurse practitioner, or dental surgeon.
When to Use
- Use C400 for a comprehensive, time-intensive consultation for a non-emergency hospital inpatient when the service requires at least 75 minutes of direct patient contact.
- Choose C400 over a standard hospital visit code like C050 when the complexity of the community medicine assessment necessitates a formal written referral and extensive evaluation time.
Common Pitfalls
- Failing to document exact start and stop times in the medical record will result in an automatic adjustment to a lower-paying assessment fee.
- Billing C400 without a formal written request from a referring physician, nurse practitioner, or dental surgeon violates the core requirement for a consultation and will trigger a rejection or audit recovery.
- Including time spent on separately billable procedures or interventions toward the 75-minute minimum requirement is a common cause for audit adjustments.
Billing Tips
- Ensure the written referral is clearly identifiable in the hospital chart, as the Ministry requires this to validate the consultation status over a standard assessment.
- When documenting, explicitly state the start and stop times for the 75 minutes of direct patient contact to ensure the claim meets the specific threshold for the C400 fee.
Effective: June 1, 2025
A. Consultations and Visits
NON-EMERGENCY HOSPITAL IN-PATIENT SERVICES
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, the written request may be contained on the common medical 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 specify the service(s) required.
The start and stop times must be recorded in the patient's permanent medical record.
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