C175 – Consultation - Non-Emergency Hospital In-Patient Services
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation is an assessment provided by a specialist (Vascular Surgery) for a non-emergency hospital in-patient, following a written request from a referring practitioner. The service requires the consultant to provide an opinion due to the complexity, seriousness, or obscurity of the case, or because a second opinion is requested. Required Elements: - A written request from a referring physician, nurse practitioner, or dental surgeon (for hospital-based dental procedures) must be kept in the consultant's medical record. - The request must identify the patient, referring practitioner (with billing number), and consultant by name, and specify the service(s) required. - The consultant must perform a general, specific, or medical specific assessment, including a review of all relevant data. - A written report with findings, opinions, and recommendations must be sent to the referring practitioner. Failure to meet these requirements may result in the service being paid as a lesser assessment fee.
When to Use
- Use C175 when a vascular surgery opinion is requested for a stable, non-emergency hospital in-patient to address a complex vascular pathology.
- Use C175 when a second opinion is formally requested by the attending physician for a patient already admitted to the hospital for a different primary diagnosis.
Common Pitfalls
- Billing C175 when the referral is initiated by a medical trainee, which leads to an automatic reduction to a lesser assessment fee.
- Using C175 for a preoperative assessment for low-risk elective procedures like carpal tunnel surgery, which is rarely considered medically necessary for a consultation fee.
- Submitting C175 when a Special Visit Premium is applicable; you must use the 'A' prefix code (A175) instead of 'C' when claiming premiums.
Billing Tips
- Ensure the written request in the hospital chart explicitly names you as the consultant and includes the referring physician's billing number to avoid audit downgrades.
- If the patient is transferred to your service, remember that only one consultation (C175) or assessment is payable per admission; subsequent visits must be billed as follow-up assessments.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Hospital and Institutional Consultations and Assessments, Consultations
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. For common medical records in hospitals, the request may be on the common record.
The request must identify the consultant by name, the referring practitioner 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.
The consultant must prepare a written report including findings, opinions, and recommendations to the referring practitioner.
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