C190 – Special Psychiatric Consultation
OHIP Surgical Procedures Code — Psychiatry (19) · Schedule of Benefits
A special psychiatric consultation is an assessment rendered to a non-emergency acute care hospital in-patient, following a written request from a referring physician, nurse practitioner, or dental surgeon. This service requires the psychiatrist to devote a minimum of 90 minutes in direct contact with the patient, exclusive of time spent rendering any other separately billable intervention to the patient. The service must include all the required elements of a consultation, such as reviewing relevant data, performing a general, specific or medical specific assessment, and providing a written report with findings, opinions, and recommendations to the referring practitioner.
When to Use
- Use C190 for a complex, non-emergency inpatient psychiatric consultation that requires a minimum of 90 minutes of direct, face-to-face patient contact.
- Use this code when you have received a formal written request from a referring physician or nurse practitioner to provide a comprehensive assessment and written report for a patient currently admitted to an acute care hospital.
Common Pitfalls
- Claiming C190 without documenting the exact start and end times of the 90-minute face-to-face interaction, which is a mandatory audit requirement.
- Billing C190 on the same day as psychotherapy or other psychiatric care codes without clearly distinct diagnoses, which will trigger an automatic rejection or recovery.
- Failing to maintain the original written referral request in the patient's chart, which is required to substantiate the consultation fee over a standard assessment.
Billing Tips
- Ensure your written report is finalized and sent to the referring practitioner, as the consultation is not considered complete for billing purposes until this documentation requirement is met.
- If the 90-minute threshold is not met, you must downgrade the claim to a standard assessment code (e.g., C195 or C198) to avoid a claim rejection for insufficient time.
Effective: June 1, 2025
Consultations and Visits
Psychiatry (19)
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
A copy of the written request for the consultation, signed by the referring practitioner, must be kept in the medical record. In a hospital where common medical records are maintained, the written 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 physician must record on the patient's permanent medical record or chart the time when the insured service started and ended.
Subject to the same conditions as A190.
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