C435 – Limited consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A limited consultation is a service rendered to a non-emergency hospital in-patient by a specialist in Internal Medicine or Occupational Medicine. It 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 and of the Schedule of Benefits. A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon for an opinion on a complex, serious, or obscure case. A copy of the written request must be kept in the patient's medical record.
When to Use
- Use C435 for a focused inpatient assessment of a specific clinical problem that does not require the extensive history, physical, or review of systems mandated by a full consultation (e.g., C135).
- Select C435 when providing a specialist opinion on a single, well-defined issue for a non-emergency inpatient, provided the referral request specifically outlines the scope of the limited inquiry.
Common Pitfalls
- Billing C435 without a valid, written referral request from a physician, nurse practitioner, or dental surgeon in the chart will lead to a rejection or a reduction to a lower assessment fee.
- Claiming C435 for a routine follow-up or a repeat visit for the same condition is incorrect; repeat consultations are not permitted under this code and should be billed as subsequent visits.
- Using C435 when the complexity of the case actually warrants a full consultation (C135) risks audit scrutiny if the documentation does not support a 'less demanding' service.
Billing Tips
- Ensure the referral request explicitly states the reason for the consultation and is signed by the referring practitioner to satisfy the documentation requirements of GP16.
- If the patient has multiple, unrelated issues, ensure the documentation clearly justifies the limited scope of the C435 to distinguish it from a more comprehensive assessment.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
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, 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, 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 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.
The limits on consultation services are applicable to all consultations, including time-based and age-specific consultation services (e.g. special, extended and comprehensive consultations) but not repeat consultations.
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