C185 – Consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered by a neurologist for a non-emergency hospital in-patient. A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon who, in light of their professional knowledge of the patient, requests the opinion of a specialist competent to give advice in this field because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient or patient's representative. The service includes all elements necessary to prepare a written report to the referring practitioner, including a review of relevant data and a general, specific, or medical specific assessment. A copy of the written request must be kept in the medical record, and it must identify the patient, the referring practitioner, and the consultant, and set out the reason for the referral. Failure to meet these requirements may result in the service fee being reduced to that of a lesser assessment.
When to Use
- Use C185 for a formal, non-emergency inpatient neurological assessment requested in writing by a primary care provider or another specialist to address a complex diagnostic or management problem.
- Use C185 when a patient or their representative specifically requests a second opinion from a neurologist regarding an existing diagnosis or treatment plan, provided the referral is documented in writing.
Common Pitfalls
- Billing C185 without a pre-existing written referral request in the chart, which triggers an automatic downgrade to a lower-paying subsequent visit code upon audit.
- Attempting to bill C185 when the referral is requested by a medical trainee (resident or fellow), as this is ineligible for consultation fees and must be billed as a visit.
- Billing C185 for emergency neurological assessments; these must be billed using the 'A' prefix codes combined with the appropriate Special Visit Premium (SVP) instead.
Billing Tips
- Ensure the referring practitioner's name and billing number are explicitly recorded in your chart note to satisfy the mandatory documentation requirements for C185.
- If you see a patient for an urgent issue that does not meet the criteria for a formal consultation, bill a subsequent hospital visit (C182) rather than attempting to force a C185 claim.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
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 identify 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 and provide a written report, including findings, opinions, and recommendations, to the referring practitioner.
C prefix codes are for non-emergency hospital in-patient services. See General Preamble to for details.
For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable - see General Preamble to .
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.