C205 – Consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation service rendered by an Obstetrics and Gynaecology specialist for a non-emergency hospital in-patient. As per , this service requires a written request from a referring physician, nurse practitioner, or dental surgeon due to the complexity, seriousness, or obscurity of the case, or at the patient's request for a second opinion. The service includes a full assessment of the patient, a review of relevant data, and the preparation of a written report to the referring practitioner. The 'C' prefix indicates the service is for an acute care hospital non-emergency in-patient (). The collection of cervical cancer screening specimen(s) is included in the fee when a pelvic examination is a normal part of the service ().
When to Use
- Use C205 for an initial inpatient consultation requested by a referring physician for a complex gynecological condition requiring a formal opinion and written report.
- Use C205 when a patient is admitted to an acute care hospital and you are requested to provide a second opinion or specialized assessment for a new, distinct clinical problem.
Common Pitfalls
- Billing C205 when the referral request was made verbally or after the service was already performed; these must be billed as a subsequent visit or assessment code.
- Attempting to bill C205 for ongoing management or follow-up visits for the same diagnosis, which should be billed as subsequent hospital visits (e.g., C202).
- Failing to document the referring physician's name and billing number, which leads to automatic rejection or recovery during an audit.
Billing Tips
- If you are attending the patient in an emergency setting or require a special visit premium, you must use the 'A' prefix code (A205) instead of C205, as 'C' codes are ineligible for special visit premiums.
- Ensure your written report is sent to the referring practitioner promptly, as the consultation fee is contingent upon the completion and documentation of this formal communication.
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 practitioner, must be kept in the consulting physician's 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 request must set out relevant information and specify the service(s) required.
A written report including findings, opinions, and recommendations must be sent to the referring practitioner.
The collection of cervical cancer screening specimen(s) is included in the consultation, repeat consultation, general or specific assessment (or re-assessment), or routine post-natal visit when pelvic examination is normal part of the foregoing services. However, the add-on codes E430 or E431 can be billed in addition to these services when collection of cervical cancer screening specimen(s) is performed outside of a hospital or IHCSC.
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