C365 – Special interventional radiological consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A special interventional radiological consultation rendered for a non-emergency, admitted hospital patient, subject to the same conditions as the general listing A365. As a 'C' prefix code, this service is specifically for acute care hospital non-emergency in-patient services. As a consultation, it requires a written request from a referring practitioner, a comprehensive assessment, and a written report back to the referring practitioner. The 'special' nature implies a more demanding service than a regular consultation, similar to other 'special' consultations described in the Schedule.
When to Use
- Use C365 for a formal, non-emergency interventional radiology consultation requested in writing for an admitted hospital patient, where the complexity of the case exceeds a standard assessment.
- Use C365 when providing a comprehensive opinion on complex imaging-guided interventions for an inpatient, ensuring the request is clearly documented in the hospital chart by the referring physician or nurse practitioner.
Common Pitfalls
- Billing C365 when the service is actually an emergency; emergency interventional radiology services should be billed using the appropriate assessment code plus the applicable Special Visit Premium (Table III).
- Failing to document the formal written request in the patient's chart, which leads to automatic downgrading of the claim to a lower-value assessment code during audit.
- Attempting to bill C365 for a follow-up assessment on the same patient admission; once the initial consultation is performed, subsequent visits must be billed as subsequent hospital visits (e.g., C002 or C003).
Billing Tips
- Ensure the referring practitioner's name and billing number are explicitly recorded in your clinical notes to satisfy the mandatory documentation requirements for consultation claims.
- If you are performing a procedure during the same visit, ensure the consultation is distinct and medically necessary, as the Ministry may scrutinize the necessity of a consultation fee when a procedural fee is also claimed on the same day.
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 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, 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 written report including findings, opinions, and recommendations must be provided to the referring practitioner.
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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