C045 – Consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation provided to a non-emergency hospital in-patient by a neurosurgeon (Specialty 04) following a written request from a referring physician, nurse practitioner, or dental surgeon.
When to Use
- Use C045 when a neurosurgeon is requested to provide a formal opinion on a non-emergency inpatient for a new clinical problem or a significant change in status.
- Use C045 as the initial assessment if you evaluate a patient in the Emergency Department and subsequently admit them to your service, as this replaces the need for a separate admission assessment.
Common Pitfalls
- Billing C045 when the referral request is missing or verbal; the request must be written and clearly identify both the consultant and the referring provider.
- Attempting to bill C045 alongside a standard admission assessment; the surgical preamble dictates that the admission assessment is included in the consultation fee.
- Billing C045 for routine follow-up visits on an existing inpatient; use C042 for subsequent visits instead.
Billing Tips
- Ensure the written report detailing your findings and recommendations is sent to the referring provider, as this is a mandatory requirement for the C045 fee to be considered valid.
- If the patient is transferred to your service from another physician, ensure the date of your first assessment is documented as the 'admission date' for all subsequent billing codes.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Institutional
Consultation
Written request from a referring physician, nurse practitioner, or dental surgeon (for hospital dental procedures).
Written report including findings, opinions, and recommendations sent to the referring provider.
Consultant must perform a general, specific, or medical specific assessment, including a review of all relevant data.
The request must identify the consultant, referring provider, and patient by name and billing/health numbers.
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 written request sets out the information relevant to the referral and specifies the service(s) required.
If the consultant assesses the patient in the ED/OPD and subsequently admits them, the initial consultation (C045) constitutes the admission assessment.
Special visit premiums (-) may apply for non-elective visits initiated by the patient or staff, but are not payable for routine rounds.
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