C180 – Special neurology consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
C180 is a special neurology consultation for a non-emergency hospital in-patient. It is subject to the same conditions as A180. A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon. The consultant's opinion is requested because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient. A special consultation is rendered when a consultant provides all the appropriate elements of a regular consultation and is required to devote a minimum of 75 minutes exclusively to the consultation with the patient. The calculation of the 75-minute minimum excludes time devoted to any other service or procedure for which an amount is payable in addition to the consultation. This service includes all common and specific elements of an assessment as outlined in the Schedule of Benefits (-).
When to Use
- Use C180 for complex neurological in-patient assessments requiring a minimum of 75 minutes of face-to-face time, such as a first-time evaluation of a patient with a complex, undiagnosed neurodegenerative condition.
- Use C180 when performing a comprehensive consultation for a patient with multi-system neurological involvement where the clinical complexity necessitates a significantly longer duration than a standard C182 consultation.
Common Pitfalls
- Billing C180 when the total time spent includes non-clinical tasks or administrative work, as the 75-minute requirement must be exclusively face-to-face with the patient.
- Attempting to claim a special visit premium (e.g., K963) with C180, which is strictly prohibited for 'C' prefix codes; use an 'A' prefix code if a special visit premium is required.
- Failing to document the exact start and end times of the 75-minute period, which is a mandatory audit requirement for all 'special' consultation codes.
Billing Tips
- Ensure the written referral specifically requests a consultation for a complex issue to justify the 'special' status, as a routine request may be downgraded to a standard C182 if audited.
- If the 75-minute threshold is not met, you must downgrade the claim to C182 to avoid automatic rejection or clawbacks during post-payment review.
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. In a hospital where common medical records are maintained, the written request may be contained on the common medical record.
The request must identify the consultant by name, 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.
The physician must record on the patient's permanent medical record the time when the insured service started and ended.
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