C260 – Special paediatric consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A special paediatric consultation is an assessment rendered in a non-emergency acute care hospital in-patient setting. It is provided following a written request from a referring physician, nurse practitioner, or other qualified practitioner for the opinion of a paediatric specialist due to the complexity, seriousness, or obscurity of the case. This service is subject to the same conditions as A260, which typically implies a minimum time requirement dedicated exclusively to the patient consultation. The service includes all the constituent elements of a consultation as defined in the Schedule of Benefits, including a comprehensive history, examination, review of data, and a written report to the referring practitioner.
When to Use
- Use C260 for an initial inpatient consultation requested by a referring physician for a complex paediatric case requiring your specialized opinion.
- Use C260 when you are providing a formal consultation in a non-emergency acute care hospital setting, ensuring the request is documented in the patient's chart.
Common Pitfalls
- Failure to record exact start and stop times in the medical record is the most frequent cause of audit recovery for C260.
- Billing C260 when the request originated from a medical trainee rather than a qualified practitioner will result in a downgrade to a standard assessment fee.
- Submitting C260 without a clear, written, and signed referral request in the chart will lead to claim rejection or adjustment during post-payment review.
Billing Tips
- Always ensure the written report to the referring practitioner is filed promptly, as this is a mandatory component of the C260 definition.
- Remember to append the appropriate age-based premium (e.g., under 16 years) to the C260 claim to maximize the specialist fee.
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 identifies the consultant by name, the referring practitioner 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.
The consultant must prepare a written report including findings, opinions, and recommendations to the referring practitioner.
The service is eligible for payment only if start and stop times of the service are recorded in the patient's permanent medical record.
Subject to the same conditions as A260.
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