C155 – Consultation - Endocrinology & Metabolism
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered to a hospital in-patient by a specialist in Endocrinology & Metabolism (15) following a written request from a referring physician, nurse practitioner, or dental surgeon.
When to Use
- Use C155 for a standard, non-emergency endocrine consultation requested for an adult hospital inpatient (17+ years).
- Use C155 when providing a formal opinion on a patient's endocrine management during their hospital stay, provided it is not an emergency, which would require A-prefix codes plus premiums.
Common Pitfalls
- Billing C155 when the patient was already seen by you in the Emergency Department prior to admission; in this case, the ED consultation (A155) is considered the admission assessment.
- Failing to document a formal written referral request in the chart, which is a mandatory requirement for all consultation codes regardless of the setting.
- Billing C155 for a patient who has already had a consultation for the same diagnosis by the same physician within the previous 12 months, unless it qualifies as a repeat consultation.
Billing Tips
- Ensure the referring physician's name and billing number are clearly documented in your consultation report to satisfy audit requirements for a valid referral.
- If the endocrine consultation is significantly more complex than a standard assessment, evaluate if C150 is more appropriate to capture the additional time and cognitive effort.
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 hospital record in a 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 sets out the information relevant to the referral and specifies the service(s) required.
The consultant must prepare a written report (including findings, opinions, and recommendations) and send it to the referring provider.
Patient aged 17 years or older. For patients 16 years of age and under, see C765.
If the consultant has previously assessed the patient for the same presenting illness within 90 days of the admission, the admission assessment may be adjusted to a reassessment fee (e.g., C154).
Age-based premiums: <30 days (30%), 30 days to <1 year (25%), 1 year to <2 years (20%), 2 years to <5 years (15%), 5 years to <16 years (10%).
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