C025 – Dermatology consultation - non-emergency hospital in-patient
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered to a non-emergency hospital in-patient by a Dermatology specialist following a written request from a referring physician, nurse practitioner, or dental surgeon. The service includes the necessary assessment and the preparation of a written report containing findings, opinions, and recommendations.
When to Use
- Use C025 for a routine, non-urgent inpatient dermatological consultation requested by the attending physician for a patient already admitted to the hospital.
- Use C025 when you are asked to provide a formal opinion on a complex dermatological condition for an inpatient, provided you generate a formal written report for the referring physician.
Common Pitfalls
- Billing C025 for emergency assessments; if the service is urgent and requires a special visit, you must use the 'A' prefix codes with the appropriate Special Visit Premium instead.
- Failing to document the formal written request or the subsequent report, which will lead to a clawback of the consultation fee to a lower assessment code during an audit.
- Billing C025 when you are the Most Responsible Physician (MRP) admitting the patient; in this scenario, the consultation is considered the admission assessment and no separate admission code is permitted.
Billing Tips
- Ensure the referring physician's name and billing number are clearly documented in your chart notes to satisfy the mandatory referral requirement for C025.
- If you are seeing the patient for a follow-up after the initial consultation, switch to C024 (Specific re-assessment) rather than attempting to bill a second C025.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Hospital In-patient
Consultation
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, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.
The request identifies the consultant by name and/or the specialty being consulted, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.
The consultant must provide a written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner or dental surgeon. Where the referral is made by a nurse practitioner, the consultant shall provide the report to the nurse practitioner and the patient’s primary care provider, if applicable.
The service must include a general, specific or medical specific assessment, including a review of all relevant data.
The written request sets out the information relevant to the referral and specifies the service(s) required.
C025 is specifically for non-emergency (routine) in-patient services.
If the consultation requirements are not met (e.g., no written request), the amount payable for a consultation will be reduced to a lesser assessment fee.
If the specialist admits the patient, the consultation (C025) constitutes the admission assessment and no separate admission assessment code is billable.
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