C245 – Consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation is an assessment rendered to a non-emergency hospital in-patient following a written request from a referring physician, nurse practitioner, or dental surgeon. The request is made because of the complexity, seriousness, or obscurity of the case, or because the patient or their representative requests another opinion. The service includes all work necessary for the consultant to prepare a written report with findings, opinions, and recommendations for the referring practitioner. As a 'C' prefix code, this service is specifically for acute care hospital non-emergency in-patient services.
When to Use
- Use C245 for a formal, requested assessment of a non-emergency hospital inpatient when you are providing a specialist opinion on a complex, serious, or obscure clinical problem.
- Use C245 when a patient or their representative specifically requests a second opinion from you regarding their ongoing inpatient management.
Common Pitfalls
- Billing C245 when the referral request is missing, backdated, or lacks the referring practitioner's billing number; this will result in a clawback during audit.
- Attempting to bill C245 for an emergency assessment; emergency inpatient services must be billed using the appropriate 'A' prefix codes and applicable special visit premiums.
- Billing C245 for a routine follow-up or subsequent visit; once the consultation is completed, subsequent visits must be billed as 'C' prefix follow-up assessments (e.g., C246).
Billing Tips
- Ensure the written request in the hospital chart explicitly states the reason for the consultation and is signed by the referring physician, nurse practitioner, or dental surgeon before you render the service.
- If you provide a consultation and a procedure on the same day, ensure the consultation note is distinct and clearly documents the complexity justifying the specialist opinion separate from the procedural work.
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 practitioner, must be kept in the medical record. For hospital in-patients, 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 information relevant to the referral and specify the service(s) required.
A written report (including findings, opinions, and recommendations) must be prepared and sent to the referring practitioner.
This service applies to non-emergency hospital in-patient services as described in the General Preamble from to .
For emergency calls and other special visits to in-patients, use General Listings ('A' prefix codes) and Premiums when applicable (see to ).
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