C286 – Limited Consultation
OHIP Surgical Procedures Code — Laboratory Medicine (28) · Schedule of Benefits
A limited consultation is an assessment which is less demanding and, in terms of time, normally requires substantially less of the physician's time than a full consultation (C285). It is rendered to a non-emergency in-patient in an acute care hospital, following a written request from a referring physician, nurse practitioner, or eligible dental surgeon. The service includes all the requirements of a full consultation, such as a written report to the referring practitioner. The request for consultation must be documented in the patient's medical record. See for full consultation requirements. This service is for specialists in Haematopathology, Neuropathology, Medical Biochemistry, Medical Microbiology, Anatomic and General Pathology.
When to Use
- Use C286 for a focused, non-emergency inpatient assessment requested by a referring practitioner when the clinical complexity does not warrant the full scope of C285.
- Use this code when providing a specialized pathology or laboratory medicine opinion on a specific diagnostic question for an inpatient, provided the written referral is documented prior to the service.
Common Pitfalls
- Billing C286 without a formal, written request from the referring practitioner in the medical record will result in a clawback to a lower assessment fee during audit.
- Submitting C286 for a patient who has already been seen by you for the same diagnosis under a previous consultation request; ongoing management must be billed as a visit, not a consultation.
- Failure to generate and send a formal written report to the referring practitioner is a common cause for rejection or reduction of the claim to a lesser assessment fee.
Billing Tips
- Ensure the written referral explicitly names you as the consultant and the referring practitioner, as missing billing numbers or names on the request document will invalidate the consultation status.
- If the consultation is performed for a patient under 16 years of age or meeting trauma criteria, ensure the relevant age premium or E420 is appended to the C286 claim to maximize the specialist fee.
Effective: June 1, 2025
Consultations and Visits
Laboratory Medicine (28)
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 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.
The consultant must prepare a written report including findings, opinions, and recommendations to the referring practitioner.
The fees for Laboratory Medicine are applicable to specialists in Haematopathology, Neuropathology, Medical Biochemistry, Medical Microbiology, Anatomic and General Pathology.
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