C225 – Genetic consultation - non-emergency hospital in-patient
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered by a specialist in Genetics (specialty 22) for a non-emergency acute care hospital in-patient. A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon. It requires a review of all relevant data and preparation of a written report to the referring practitioner. The 'C' prefix designates this service for non-emergency hospital in-patients. For full consultation requirements, see General Preamble through . Note: This service is payable at nil if a genetic assessment (K016) or genetic care (K222) has previously been claimed by the same physician.
When to Use
- Use C225 for the initial inpatient evaluation of a patient with a suspected genetic disorder when a formal written referral request is received from the attending physician or nurse practitioner.
- Use C225 when providing a comprehensive genetic consultation for a hospitalized patient who has not previously been seen by you for the same condition via K016 or K222.
Common Pitfalls
- Claiming C225 after having already billed K016 or K222 for the same patient, which will result in a nil payment.
- Failing to document a formal written request in the hospital chart, which is a mandatory requirement for the 'Consultation' designation under GP16.
- Billing C225 for a patient seen in an emergency department setting, as C225 is strictly for non-emergency acute care hospital inpatients; use emergency-specific codes if applicable.
Billing Tips
- Ensure the written consultation report is clearly dated and includes the referring practitioner's name and billing number to satisfy audit requirements for a valid consultation.
- If you provide ongoing management after the initial consultation, switch to subsequent visit codes (e.g., C220) to avoid the restriction associated with K222.
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, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.
The request identifies the consultant by name, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.
The written request sets out the information relevant to the referral and specifies the service(s) required.
A written report (including findings, opinions, and recommendations) must be prepared and delivered to the referring physician, nurse practitioner or dental surgeon.
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