C130 – Comprehensive internal medicine consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered by a specialist in internal medicine who provides all the appropriate elements of a consultation and spends a minimum of seventy-five (75) minutes of direct contact with the patient exclusive of time spent rendering any other separately billable intervention to the patient.
When to Use
- Use C130 for complex, multi-system hospital in-patient assessments where the clinical complexity necessitates at least 75 minutes of direct face-to-face time, exceeding the scope of a standard C135 consultation.
- Use C130 when you are the Most Responsible Physician (MRP) performing the initial comprehensive admission assessment for a patient with significant comorbidities requiring extensive history taking and physical examination.
Common Pitfalls
- Including non-patient-facing time, such as chart review or report dictation, in the 75-minute calculation will lead to audit rejection; only direct patient contact counts.
- Failing to record exact start and stop times in the medical record is the most frequent cause of payment adjustment to the lower-valued C135 code.
- Billing C130 on the same day as other separately billable interventions without explicitly excluding that intervention time from the 75-minute total is a common compliance error.
Billing Tips
- If you are the MRP, ensure you append the E082 premium to your C130 claim to capture the additional 30% fee increase for the admission assessment.
- Always document the specific clinical rationale for the extended 75-minute duration in your consultation note to defend against potential Ministry of Health audits.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Hospital In-patient
Consultation
A written request from a referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician’s medical record (or common medical record in hospital, long-term care institution or multi-specialty clinic).
The request must identify the consultant by name and/or specialty, the referring physician, nurse practitioner or dental surgeon by name and billing number, and the patient by name and health number.
The written request must set out the information relevant to the referral and specify the service(s) required.
A written report (including findings, opinions, and recommendations) must be provided to the referring physician, nurse practitioner or dental surgeon (and the patient’s primary care provider, if applicable, for nurse practitioner referrals).
Minimum of seventy-five (75) minutes of direct contact with the patient exclusive of time spent rendering any other separately billable intervention to the patient.
The start and stop times must be recorded in the patient’s permanent medical record.
Must satisfy all elements of a consultation as defined in (general, specific or medical specific assessment, including a review of all relevant data).
17 years of age and older
Calculation of time excludes non-patient-facing time (e.g., chart review, documentation) and time for other billable services.
If the patient was assessed in the ED/OPD by the same specialist and then admitted, the initial assessment constitutes the admission assessment (C130).
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