C802 – Extended midwife or aboriginal midwife-requested genetic assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
An extended midwife or aboriginal midwife-requested genetic assessment rendered to a non-emergency in-patient of an acute care hospital. This service is subject to the same conditions as a midwife or aboriginal midwife-requested genetic assessment (A802). The 'C' prefix designates this service for non-emergency in-patient settings (, ). As an assessment, this service must include the specific elements outlined in the Schedule, such as a direct physical encounter with the patient, history taking, and physical examination ().
When to Use
- Use C802 when a midwife requests a formal genetic assessment for an admitted hospital patient, distinguishing it from an A802 which is strictly for office-based or outpatient settings.
- Select C802 over a standard C003 hospital visit when the primary purpose of the encounter is a specialized genetic consultation initiated by a midwife referral.
Common Pitfalls
- Failure to send a written report to both the referring midwife and the primary care physician will result in a mandatory fee reduction to a lower-valued assessment code.
- Billing C802 for an emergency admission is a common audit trigger; ensure the patient status is coded as non-emergency in the hospital record to align with the 'C' prefix requirements.
Billing Tips
- Ensure the midwife's written request is physically or digitally attached to the patient's permanent hospital chart to satisfy the documentation requirement for the full specialist fee.
- Always verify that the referral source is explicitly a midwife or aboriginal midwife, as using this code for physician-referred genetic consults is incorrect and should be billed under the C800/C801 series instead.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
The written request from the midwife or aboriginal midwife must be retained on the patient’s permanent medical record, or the amount payable for the service will be reduced to a lesser fee.
Subject to the same conditions as A802.
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