C375 – Limited consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A limited consultation is a consultation 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 as defined in . A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon (in specific hospital settings). The consultant provides an opinion because of the complexity, seriousness, or obscurity of the case, or because a second opinion is requested. The service includes the services necessary to enable the consultant to prepare a written report (including findings, opinions, and recommendations) to the referring practitioner. Except where otherwise specified, the consultant is required to perform a general, specific or medical specific assessment, including a review of all relevant data. See for full consultation requirements.
When to Use
- Use C375 for a focused, time-limited consultation on a hospital inpatient where the clinical complexity does not warrant the full scope of a C075 consultation.
- Select C375 when providing a second opinion on a specific, narrow clinical question for an inpatient that requires a formal report but less comprehensive data review than a full consultation.
Common Pitfalls
- Billing C375 for a patient seen by a medical trainee without the consultant performing and documenting their own independent assessment will lead to a reduction to a lesser assessment fee.
- Submitting C375 without a clear, written referral request from a physician, nurse practitioner, or dental surgeon in the patient's chart is a frequent cause of audit recovery.
- Using C375 for a patient who has already been seen by your specialty for the same condition within the last 12 months will result in the claim being adjusted to a subsequent visit fee.
Billing Tips
- Ensure your written report explicitly addresses the specific question posed by the referring practitioner to justify the 'consultation' status over a standard 'assessment' code.
- Always append the appropriate hospital special visit premium (e.g., C986) to C375 when the visit meets the criteria for a special call to the hospital 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.
The written request sets out the information relevant to the referral and specifies the service(s) required.
The consultant is required to prepare a written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner or dental surgeon.
Service is for non-emergency hospital in-patient services.
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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