C285 – Consultation
OHIP Surgical Procedures Code — Laboratory Medicine (28) · Schedule of Benefits
A consultation is an assessment rendered for a non-emergency hospital in-patient following a written request from a referring physician, nurse practitioner, or dental surgeon (in connection with an insured dental procedure rendered in a hospital). The request is made because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient. The service is rendered by a specialist in Laboratory Medicine (28), which includes Haematopathology, Neuropathology, Medical Biochemistry, Medical Microbiology, Anatomic and General Pathology. It includes all services necessary to prepare a written report with findings, opinions, and recommendations for the referring practitioner. A copy of the written request must be kept in the medical record. If the requirements are not met, the service may be paid as a lesser assessment.
When to Use
- Use C285 when you are a specialist in Laboratory Medicine providing a formal, requested assessment for a non-emergency hospital inpatient.
- Use C285 when the complexity or obscurity of a case requires a written opinion beyond routine diagnostic reporting, provided a valid referral is documented.
Common Pitfalls
- Billing C285 without a formal written request from the referring practitioner will result in a downgrade to a lesser assessment fee upon audit.
- Attempting to bill C285 for the same diagnosis within a 12-month period for the same patient will trigger a rejection or payment adjustment unless it qualifies as a repeat consultation.
- Confusing C285 with A285; remember that C-prefix codes are strictly for non-emergency hospital inpatients, whereas A-prefix codes apply to office or emergency settings.
Billing Tips
- Ensure your documentation explicitly references the referring practitioner's name and billing number to satisfy the mandatory referral requirements for C285.
- If the patient is under 16 years of age, remember to append the appropriate age-based premium to your C285 claim to maximize the specialist fee.
Effective: June 1, 2025
Consultations and Visits
Laboratory Medicine (28)
Consultation
Hospital and Institutional Consultations and Assessments, Consultations
The 'C' prefix indicates this service is for non-emergency hospital in-patient services.
See General Preamble to for rules on Hospital and Institutional Consultations and Assessments.
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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