C345 – Consultation
OHIP Surgical Procedures Code — RADIATION ONCOLOGY (34) · Schedule of Benefits
A consultation is an assessment of a non-emergency hospital in-patient rendered by a specialist in Radiation Oncology (34) following a written request from a referring physician, nurse practitioner, or dental surgeon. The consultant physician provides an opinion due to the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient. The service includes all elements necessary to prepare a written report of findings, opinions, and recommendations to the referring practitioner. This service is for an acute care hospital non-emergency in-patient setting.
When to Use
- Use C345 when providing a formal, requested opinion on a non-emergency hospital in-patient for a complex radiation oncology case.
- Use C345 when the referring physician or nurse practitioner specifically requests your expert assessment for a patient already admitted to an acute care facility.
Common Pitfalls
- Billing C345 without a documented, written referral request from the attending physician or nurse practitioner, which will lead to a downgrade to a lower assessment fee upon audit.
- Submitting C345 for a patient who is not an in-patient in an acute care hospital, as this code is strictly restricted to the in-patient setting.
- Failing to send a formal written report back to the referring practitioner, which is a mandatory requirement to qualify for the consultation fee.
Billing Tips
- Ensure the written referral request explicitly states the reason for the consultation and the specific service required to satisfy the documentation requirements for C345.
- Always verify that the referring practitioner's billing number is included in your documentation to ensure compliance with the OHIP Schedule of Benefits.
Effective: June 1, 2025
A. Consultations and Visits
RADIATION ONCOLOGY (34)
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 contained on the common medical record.
The request identifies the consultant by name, 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.
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