C215 – Limited consultation for acute pain management
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A limited consultation for acute pain management rendered by an Anaesthesiologist (specialty 01) to a non-emergency hospital in-patient. A limited consultation is defined as being less demanding and normally requiring substantially less of the physician's time than a full consultation. However, it must meet all other requirements for a consultation, which includes: - A written request from a referring physician, nurse practitioner, or dental surgeon. - An assessment of the patient due to the complexity, seriousness, or obscurity of the case. - A written report of findings, opinions, and recommendations sent to the referring practitioner. This service is subject to the same conditions as A215 as specified in the Schedule of Benefits.
When to Use
- Use C215 for a formal, requested assessment of a hospitalized patient's acute pain management plan where a full consultation (A215) is not required due to the limited scope of the request.
- Use C215 when providing a specialized pain management opinion for a patient already admitted under another service, provided a written request from the attending physician is present in the chart.
Common Pitfalls
- Billing C215 alongside a Special Visit Premium (SVP) will result in rejection; you must use A215 with the appropriate 'C' prefix premium code instead.
- Failing to document a formal written request from the referring practitioner in the patient's chart is the most common cause for clawbacks during audits.
- Submitting C215 for routine follow-up visits or daily pain management rounds is inappropriate, as this code is strictly for a consultation service.
Billing Tips
- Ensure your written report is distinct from the daily progress note and explicitly addresses the referring practitioner's specific question to satisfy the consultation requirements.
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 on the common record.
The written request must identify the consultant by name, the referring practitioner by name and billing number, and the patient by name and health number.
The consultant must prepare a written report of their findings, opinions, and recommendations to be sent to the referring practitioner.
The written request sets out the information relevant to the referral and specifies the service(s) required.
subject to the same conditions as A215
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