C315 – Physical Medicine & Rehabilitation Consultation - Non-Emergency Hospital In-Patient
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation is an assessment rendered by a specialist in Physical Medicine & Rehabilitation for a non-emergency hospital in-patient, following a written request from a referring practitioner (physician, nurse practitioner, or dental surgeon for in-hospital dental procedures). The service is requested due to the complexity, seriousness, or obscurity of the case, or because a second opinion is sought. Required Elements: - A written request from the referring practitioner must be retained in the patient's medical record. - The consultant must perform a general, specific, or medical specific assessment, including a review of all relevant data. - The consultant must prepare a written report with findings, opinions, and recommendations for the referring practitioner.
When to Use
- Use C315 when a hospitalist or primary team requests a formal Physiatry opinion for a patient with complex functional deficits or rehabilitation needs during an inpatient stay.
- Use C315 for a requested second opinion on a patient's rehabilitation potential or complex musculoskeletal management plan while they are admitted to a non-emergency ward.
Common Pitfalls
- Claiming C315 when the service is initiated by the specialist rather than requested by the referring practitioner; this results in a downgrade to a subsequent hospital visit fee.
- Attempting to bill C315 in conjunction with special visit premiums; C-prefix codes are ineligible for these, and you must use A-prefix codes if the service meets emergency criteria.
- Failing to document the specific written request in the chart, which triggers an automatic adjustment to a lower assessment fee during audit.
Billing Tips
- Ensure the referring physician's name and billing number are clearly documented in your consultation report to satisfy the mandatory referral requirements.
- If you are seeing the patient for follow-up visits after the initial consultation, switch to the appropriate subsequent visit code (e.g., C316) to avoid rejection.
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 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 and/or the specialty being consulted, 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 consultation includes the services necessary to enable the consultant to prepare a written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner or dental surgeon.
See General Preamble to for rules regarding non-emergency hospital in-patient services.
For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable - see General Preamble to .
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