C445 – Consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation is an assessment rendered by a specialist in Medical Oncology for a non-emergency hospital in-patient, following a written request from a referring physician, nurse practitioner, or dental surgeon (for an insured dental procedure in a hospital). The consultant's opinion is sought due to the complexity, seriousness, or obscurity of the case, or at the request of the patient or their representative. The service includes all necessary work to prepare a written report with findings, opinions, and recommendations for the referring practitioner. A general, specific, or medical specific assessment, including a review of all relevant data, is required.
When to Use
- Use C445 for a formal, non-emergency consultation requested by another physician for an oncology patient already admitted to a hospital ward.
- Use this code when providing a comprehensive assessment and written opinion on a complex oncology case that meets the criteria for a consultation, provided it is not an emergency.
Common Pitfalls
- Billing C445 for emergency in-patient assessments; these must be billed using the corresponding 'A' prefix code (A445) plus the appropriate Special Visit Premium.
- Failing to document a formal written request from the referring practitioner, which is a mandatory requirement for all 'C' prefix consultation codes.
- Billing C445 when the patient has already been assessed by the admitting physician for the same illness within 90 days, as this triggers a downgrade to a re-assessment fee.
Billing Tips
- Ensure your written report is sent to the referring physician, as the Ministry requires this documentation to validate the consultation fee.
- If the patient is in an ICU or CCU, remember to add the C101 premium to your C445 claim to capture the additional fee for intensive care settings.
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, 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.
See General Preamble to for rules regarding 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 General Preamble to .
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