C135 – Consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered by a specialist in Internal Medicine (13) to a hospital in-patient in a non-emergency setting. This service includes the necessary assessment and a written report to the referring physician, nurse practitioner, or dental surgeon.
When to Use
- Use C135 for the initial comprehensive assessment of a hospitalized patient when a formal written request is received from another physician, NP, or dental surgeon.
- Use C135 when you are providing a specialist opinion on a new, distinct clinical problem for a patient already admitted to the hospital, provided the 12-month rule for unrelated diagnoses is met.
Common Pitfalls
- Billing C135 when the referral request was not documented or received prior to the service, which defaults the claim to a lower-value subsequent visit fee during audit.
- Attempting to bill C135 alongside an admission assessment if you are the MRP, as the Ministry considers the initial consultation to be the admission assessment.
- Applying the 15% age premium for patients 65+ to C135, which is explicitly disallowed for consultation codes.
Billing Tips
- If you are the MRP, ensure you append the E082 premium to your C135 claim to capture the 30% increase for the admission assessment component.
- If the clinical scenario is less complex and does not meet the full requirements of a comprehensive consultation, bill C435 (Limited Consultation) to avoid rejection or audit adjustments.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Non-Emergency Hospital In-Patient Services
Consultation
Written request from a referring physician, nurse practitioner, or dental surgeon.
Written report including findings, opinions, and recommendations sent to the referrer.
The request must identify the consultant, the referrer, and the patient.
A copy of the request must be maintained in the medical record.
Patient age 17 years and older
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