C235 – Ophthalmology Consultation - Non-Emergency Hospital In-Patient
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered by a physician with the specialty designation of Ophthalmology (23) for a non-emergency hospital in-patient. As per , a consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon who requests the opinion of a consultant physician because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient or patient's representative. It includes the services necessary to prepare a written report to the referring practitioner. The consultant is required to perform a general, specific or medical specific assessment, including a review of all relevant data. A copy of the written request must be kept in the patient's medical record.
When to Use
- Use C235 when a hospital in-patient requires an ophthalmological opinion for a non-emergency condition, such as a chronic ocular manifestation of a systemic disease, following a formal written request from the attending physician.
- Use C235 for a scheduled, non-urgent ophthalmic assessment of an admitted patient where the primary goal is to provide a diagnostic opinion or management plan to the referring team.
Common Pitfalls
- Billing C235 for a patient seen in the Emergency Department; C235 is strictly for hospital in-patients, and emergency visits should be billed using 'A' prefix codes.
- Failing to document a formal written request from the referring practitioner, which leads to automatic downgrading of the claim to a lower-value assessment code during audit.
- Attempting to bill C235 for routine preoperative cataract assessments, which are considered non-payable unless specific, rare medical necessity is documented.
Billing Tips
- Ensure the written referral is physically present in the patient's chart or the hospital's common medical record, clearly identifying both the consultant and the referring practitioner by name and billing number.
- If the patient is located in an Intensive Care Unit (ICU) or Coronary Care Unit (CCU), remember to add the C101 premium to the C235 claim to maximize the service value.
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 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 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.
See General Preamble to for Non-Emergency Hospital In-Patient Services.
For emergency calls and other special visits to in-patients, use General Listings ('A' prefix codes) and Premiums when applicable - see General Preamble to .
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