C075 – Geriatric Consultation - Non-Emergency Hospital In-Patient
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered to a hospital in-patient by a specialist in Geriatrics (07) following a written request from a referring physician, nurse practitioner, or dental surgeon. It includes a comprehensive assessment (general, specific, or medical specific) and a written report back to the referrer.
When to Use
- Use C075 for the initial geriatric consultation of a hospital inpatient when requested by the MRP for a complex geriatric syndrome, such as delirium or falls, that requires a comprehensive assessment.
- Use C075 when the patient has been admitted to the hospital and you are providing a formal consultation that meets the requirement of a written request and a subsequent written report to the referrer.
Common Pitfalls
- Billing C075 when the service provided is actually a repeat consultation; ensure you use C076 if you have already billed a consultation for the same diagnosis within the last 12 months.
- Failing to document the written referral in the hospital chart; even if the request is verbal, it must be documented as a formal request in the patient's record to satisfy audit requirements.
- Attempting to bill the 15% age 65+ premium on C075; this premium is explicitly excluded for all consultation codes in the Schedule of Benefits.
Billing Tips
- If the patient is highly complex and requires significantly more time than a standard consultation, evaluate if the criteria for C775 (Comprehensive Geriatric Consultation) are met instead of C075 to capture the increased complexity.
- Ensure the written report to the referring physician is dated and filed in the hospital chart, as this is the primary document auditors look for to validate the C075 fee.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
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 written request sets out the information relevant to the referral and specifies the service(s) required.
Written report to the referring provider including findings, opinions, and recommendations.
If consultation requirements are not met, the fee is reduced to a lesser assessment fee
For emergency calls or special visits, use General Listings and Premiums (-)
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