C015 – Consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon (for insured dental procedures in hospital). The consultant physician must be competent to give advice due to the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient. The service includes a written report of findings, opinions, and recommendations to the referring provider.
When to Use
- Use C015 when a patient is admitted to the hospital and you receive a formal written request for a specialist opinion on a complex or obscure clinical problem.
- Use C015 for a medically necessary pre-operative assessment for a high-risk patient where the complexity of the case requires a formal consultation report to the referring physician.
Common Pitfalls
- Billing C015 for routine pre-anaesthetic evaluations is a common audit trigger; these are included in the anaesthesia service fee and are not separately billable.
- Failing to document the written referral request in the chart or neglecting to send a formal written report to the referring provider will result in a clawback to a lower assessment fee.
- Billing C015 when you have already assessed the patient for the same illness within the previous 90 days, which should instead be billed as a re-assessment.
Billing Tips
- If you are the Most Responsible Physician (MRP) performing the admission assessment, remember to add the E082 premium to the C015 code to increase the fee by 30%.
- Always append the appropriate 'C' prefix special visit premium to C015 if the consultation was performed during an emergency call or unscheduled visit to the hospital.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Hospital In-Patient
Consultation
A written request from a referring physician, nurse practitioner, or dental surgeon must be recorded in the patient's medical record.
The consultant must provide a written report to the referring provider.
The service must include a general, specific, or medical specific assessment and a review of all relevant data.
Routine pre-anaesthetic evaluations required by the Public Hospitals Act do not constitute a consultation and are included in the anaesthesia service fee.
Subject to the same conditions as A015 (office/out-patient consultation).
If the referral is from a nurse practitioner, the report must be sent to the NP and the patient's primary care provider (if applicable).
If the requirements for a consultation are not met (e.g., no written request), the fee will be adjusted to a lesser assessment fee.
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