C095 – Consultation - Cardiac Surgery - Non-Emergency Hospital In-Patient
OHIP Surgical Procedures Code — CARDIAC SURGERY (09) · Schedule of Benefits
A consultation rendered to a non-emergency hospital in-patient by a Cardiac Surgeon following a written request from a referring physician, nurse practitioner, or dental surgeon.
When to Use
- Use C095 when you are the cardiac surgeon providing an initial, non-emergency consultation for an inpatient following a formal written request from an MRP or other eligible provider.
- Use C095 as the base code when you are the Most Responsible Physician (MRP) for the admission, allowing you to add the E082 premium for a 30% increase.
- Use C095 for the 'major preoperative visit' where the decision to proceed with cardiac surgery is finalized and documented.
Common Pitfalls
- Claiming C095 when the service duration exceeds 50 minutes of direct patient contact; you must use C935 instead to capture the higher complexity.
- Billing C095 without a documented written referral request in the chart, which triggers automatic rejection or clawbacks during OHIP audits.
- Attempting to bill C095 for a patient you have already assessed for the same presenting illness within the previous 90 days, which must be billed as a re-assessment (C094) instead.
Billing Tips
- Always append E082 to C095 if you are the MRP for the admission to maximize the fee, provided you are not performing a transfer within the same hospital.
- Ensure the written referral request is clearly dated and identifies both the referring provider and the consultant to meet the mandatory documentation requirements for a consultation.
Effective: June 1, 2025
A. Consultations and Visits
CARDIAC SURGERY (09)
Hospital In-Patient
Consultation
A written request from a referring physician, nurse practitioner, or dental surgeon (for insured dental procedures in hospital) is mandatory.
The consultant must prepare a written report (findings, opinions, recommendations) and send it to the referring provider.
The request must identify the consultant, the referrer, and the patient by name and billing/health numbers.
A copy of the written request must be kept in the medical record (common hospital records are acceptable).
For emergency calls and other special visits to in-patients, use General Listings and Special Visit Premiums ( to ) when applicable.
Non-emergency hospital in-patient services are governed by General Preamble to .
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