C355 – Consultation - Non-Emergency Hospital In-Patient Services
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered by a specialist in Urology for a non-emergency hospital in-patient. This service requires a written request from a referring physician, nurse practitioner, or dental surgeon (for an insured hospital dental procedure) for an opinion on a complex, serious, or obscure case. The service includes a comprehensive assessment, review of relevant data, and a written report of findings, opinions, and recommendations sent back to the referring practitioner. The specific requirements for a consultation, including documentation of the referral, are outlined in of the Schedule. This service is performed in an acute care hospital for a non-emergency in-patient, as indicated by the 'C' prefix ().
When to Use
- Use C355 when a urology specialist is requested by a referring practitioner to provide a formal opinion on a non-emergency, complex, or obscure urological case for an admitted hospital in-patient.
- Use C355 for the initial assessment of a patient transferred to your service for a specific urological opinion, provided the written referral request is documented in the hospital chart prior to the service.
- Use C355 when the patient requires a comprehensive urological evaluation that exceeds the scope of a standard subsequent visit (C356) and meets all GP16 consultation requirements.
Common Pitfalls
- Billing C355 for emergency admissions where a special visit premium would otherwise apply; C-prefix codes are strictly for non-emergency, scheduled in-patient consultations and are ineligible for special visit premiums.
- Failing to document the specific written referral request in the patient's chart, which leads to automatic downgrades to a lower-paying assessment code upon audit.
- Submitting C355 when the referral request was solicited by the consultant after the service was already performed, which renders the consultation ineligible for payment.
Billing Tips
- Ensure the referring practitioner's billing number is clearly recorded in your documentation to satisfy the GP16 requirement for a valid consultation claim.
- If you are seeing a patient in the emergency department, use the appropriate A-prefix code (e.g., A355) combined with applicable special visit premiums rather than C355, as C-prefix codes are restricted to non-emergency in-patient settings.
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 practitioner, 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.
This service applies to non-emergency hospital in-patient services. See to for details.
For emergency calls and other special visits to in-patients, use General Listings ('A' prefix codes) and Premiums when applicable. See to .
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