C065 – Consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered to a hospital in-patient by an Orthopaedic Surgeon (specialty 06) following a written request from a referring physician, nurse practitioner, or dental surgeon. It includes the necessary assessment and a written report back to the referrer.
When to Use
- Use C065 as the initial admission assessment when you are the Most Responsible Physician (MRP) admitting a patient to the hospital for an orthopaedic condition.
- Use C065 when you are requested by another physician to provide an expert opinion on a patient already admitted to the hospital under a different service.
Common Pitfalls
- Billing C065 when you have already provided a consultation or assessment for the same diagnosis within the previous 12 months, which triggers an automatic rejection.
- Failing to document a formal written request from the referring provider, which leads to a downgrade to a lower-paying assessment code during an audit.
- Billing C065 on the same day as a C064 or C063 for the same patient, as only one assessment code is permitted per day.
Billing Tips
- Always append the E082 premium to C065 if you are the admitting physician, as this provides a 30% increase to the consultation fee.
- Ensure the written request and your subsequent consultation report are clearly dated and filed in the hospital chart to satisfy the mandatory documentation requirements for this code.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Hospital In-Patient
Consultation
Written request from a referring physician, nurse practitioner, or dental surgeon (for hospital-based dental procedures).
The request must be kept in the medical record (common hospital records are acceptable).
The consultant must provide a written report (findings, opinions, recommendations) to the referring provider.
The service includes a general, specific, or medical specific assessment and a review of all relevant data.
If consultation requirements (request/report) are not met, the fee is adjusted to a lesser assessment fee.
Preoperative consultations for low-risk elective procedures (e.g., cataract, colonoscopy, arthroscopic surgery) are only eligible if the medical record demonstrates medical necessity.
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