C385 – 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. A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner or dental surgeon who requests the opinion of a consultant physician because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient or patient's representative. A copy of the written request must be kept in the medical record. This service is specifically for a non-emergency in-patient of an acute care hospital, as indicated by the 'C' prefix.
When to Use
- Use C385 when a specialist provides a focused, less time-intensive opinion on an acute care in-patient following a formal written request from a referring practitioner.
- Choose C385 over C185 when the clinical complexity or time required does not meet the threshold for a full consultation, provided the referral criteria are still satisfied.
Common Pitfalls
- Attempting to bill C385 with special visit premiums (e.g., K963) will result in rejection; use an 'A' prefix code if a special visit premium is required.
- Failure to maintain a copy of the written request in the patient's chart is a frequent audit trigger that results in the claim being downgraded to a lower-value assessment fee.
- Billing C385 for a patient who is not an acute care in-patient; the 'C' prefix is strictly reserved for hospital in-patient settings.
Billing Tips
- Ensure the written referral explicitly states the reason for the consultation and the specific service requested to satisfy the documentation requirements for a valid consultation claim.
- If you are providing care in an ICU or CCU, remember to add the C101 premium to your C385 claim to maximize the value of the service.
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. In a hospital where common medical records are maintained, the written request may be contained 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.
See General Preamble to .
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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