C335 – Radiology second opinion of PET study
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Consultation - subject to the same conditions as A335
When to Use
- Use C335 when providing a formal second opinion on a PET study for a hospitalized patient, specifically when requested by the attending physician to resolve diagnostic uncertainty.
- Use this code when the clinical question requires a comprehensive review of the PET images and a formal written report that goes beyond a standard diagnostic interpretation.
Common Pitfalls
- Billing C335 without a formal, written request from the attending physician, which is a mandatory requirement for all consultation codes.
- Attempting to bill C335 for routine interpretation or follow-up of a previously interpreted study, which does not meet the definition of a consultation.
- Failing to include the referring physician's billing number on the claim, which will result in an automatic rejection.
Billing Tips
- Ensure the medical record explicitly documents the clinical question posed by the referring physician and your formal response, as this is the primary evidence required during an audit.
- If the consultation is performed in a hospital setting where common medical records are maintained, ensure the referral request is clearly documented in the patient's chart to satisfy the documentation requirement.
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 where common medical records are maintained.
The written request must identify the consultant by name, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identify the patient by name and health number.
The written request sets out the information relevant to the referral and specifies the service(s) required.
Subject to the same conditions as A335.
See General Preamble to for 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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