C325 – Limited consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
C325 is a limited consultation rendered by a specialist in Genetics (22) for a non-emergency hospital in-patient. The 'C' prefix indicates the service is for an acute care hospital non-emergency in-patient (see ). A limited consultation is defined as an assessment which is less demanding and, in terms of time, normally requires substantially less of the physician's time than the full consultation. Otherwise, a limited consultation has the same requirements as a full consultation, including a written request from a referring practitioner, documentation of the request in the patient's record, and a written report sent back to the referring practitioner (see , ).
When to Use
- Use C325 for a focused genetic assessment of an inpatient where the clinical question is narrow and does not require the comprehensive review associated with a full consultation (C225).
- Select C325 when providing a second opinion on a specific genetic finding for an inpatient, provided the service meets all formal consultation requirements including a written request and report.
Common Pitfalls
- Billing C325 after previously claiming K016 or K222 for the same patient will result in a zero-dollar payment as these codes are mutually exclusive.
- Failing to document a formal written request from the referring physician or nurse practitioner in the hospital chart will lead to a clawback during an audit, as C325 requires the same referral rigor as a full consultation.
- Using C325 for emergency inpatient assessments is incorrect; emergency services require an A-prefix code combined with the appropriate Special Visit Premium.
Billing Tips
- Ensure the written report to the referring practitioner is clearly dated and filed in the patient's record to substantiate the consultation claim.
- Apply the appropriate age-based premium to C325 if the patient is under 16 years of age to maximize the claim value.
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.
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. 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.
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