C223 – Extended special genetic consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
An extended special genetic consultation for a non-emergency hospital in-patient. This service is subject to the same conditions as A223. As a 'C' prefix code, this service is rendered in an acute care hospital for a non-emergency in-patient. A consultation requires a written request from a referring practitioner and a written report of findings and recommendations must be sent back. The 'extended special' nature implies it is more demanding and time-consuming than a standard consultation, and the physician spends a minimum of 90 minutes in direct contact with the patient with or without family, exclusive of time spent rendering any other separately billable intervention to the patient.
When to Use
- Use C223 for complex inpatient genetic evaluations requiring at least 90 minutes of direct patient or family contact, such as counseling for multi-system congenital anomalies or complex metabolic disorders.
- Select C223 over a standard C023 consultation when the clinical complexity necessitates an extended, in-depth review of genetic history and pedigree analysis that exceeds standard time thresholds.
Common Pitfalls
- Billing C223 after previously claiming K016 or K222 for the same patient will result in a zero-dollar payment due to strict restriction rules.
- Failing to document the exact start and end times of the 90-minute direct contact period is a frequent cause of audit recovery, as this code is specifically time-dependent.
- Submitting C223 without a formal written referral request from the attending physician or nurse practitioner will lead to a downgrade to a standard assessment fee.
Billing Tips
- Ensure the written consultation report explicitly details the complexity of the genetic counseling provided to justify the 'extended' nature of the service beyond a standard consultation.
- If the patient is less than 30 days old, remember to manually apply the 30% age premium, as this is not always automatically triggered by the base code.
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 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.
A written report including findings, opinions, and recommendations must be sent to the referring practitioner.
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