C231 – Neuro-Ophthalmology Consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A neuro-ophthalmology consultation rendered for a non-emergency hospital in-patient, subject to the same conditions as A231. As a consultation, it requires a written request from a referring physician, nurse practitioner, or dental surgeon due to the complexity, seriousness, or obscurity of the case. The consultant must review all relevant data, perform an appropriate assessment, and provide a written report with findings, opinions, and recommendations to the referring practitioner. A copy of the written request must be maintained in the patient's medical record. See for full consultation requirements.
When to Use
- Use C231 for a formal, requested neuro-ophthalmological evaluation of an admitted hospital inpatient when the case requires specialized expertise beyond a standard ophthalmology consult.
- Use this code when the patient has been transferred to your service or requested for a specific neuro-ophthalmological opinion regarding a complex condition like optic neuritis or unexplained visual field loss while in the hospital.
Common Pitfalls
- Billing C231 for a patient who is not an inpatient; this code is strictly for hospital-based services, whereas A231 is the equivalent for office-based consultations.
- Failing to document the specific written request from the referring physician, which is a mandatory audit requirement for all consultation codes.
- Submitting C231 when the referring physician did not provide a formal request prior to the service, which will lead to a clawback to a lower-valued assessment fee.
Billing Tips
- Ensure the referring physician's name and billing number are clearly documented in your clinical notes to satisfy the GP16 requirements for a valid consultation claim.
- If you are seeing the patient for a follow-up visit after the initial consultation, do not use C231 again; switch to the appropriate subsequent visit code (e.g., C236) to avoid rejection.
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 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 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 provided to the referring physician, nurse practitioner or dental surgeon.
Subject to the same conditions as A231.
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