C275 – Limited consultation - infectious disease - non-emergency hospital in-patient
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A limited consultation for a non-emergency hospital in-patient, as defined in the Schedule of Benefits (:33). This service involves an assessment that is less demanding and requires substantially less physician time than a full consultation, but must otherwise meet all requirements for a consultation. A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon, requiring the specialist's opinion due to the complexity, seriousness, or obscurity of the case (:30). The service includes reviewing relevant data and providing a written report to the referring practitioner. As a 'C' prefix code, this service is specifically for in-patients in an acute care hospital (:26).
When to Use
- Use C275 when you are requested to provide a focused infectious disease opinion on an existing hospital inpatient that does not require the full complexity of a major consultation (C465).
- Use this code for a follow-up consultation on a patient if the clinical situation has evolved to meet the criteria for a new, distinct consultation request from the attending physician.
Common Pitfalls
- Billing C275 when the request is merely for daily follow-up or supportive care, which should be billed as a subsequent visit (C272) rather than a consultation.
- Failing to ensure the medical record contains a clear, written request from the referring physician, which is a mandatory requirement for all 'C' prefix consultation codes.
- Billing C275 for a patient seen in the Emergency Department; 'C' codes are strictly for admitted hospital inpatients, whereas 'A' codes (A275) apply to outpatients.
Billing Tips
- Ensure your documentation explicitly references the referring physician's name and the specific clinical question asked to satisfy the audit requirements for a valid consultation.
- If the patient is in an ICU or CCU, remember to add the C101 premium to your C275 claim to capture the additional setting-based 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 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 provided to the referring physician, nurse practitioner or dental surgeon. Where the referral is made by a nurse practitioner, the consultant shall provide the report to the nurse practitioner and the patient's primary care provider, if applicable.
For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.