C460 – Comprehensive infectious disease consultation - non-emergency hospital in-patient
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A comprehensive infectious disease consultation rendered to a non-emergency hospital in-patient by a specialist in infectious disease. This service requires the physician to provide all appropriate elements of a consultation and spend a minimum of seventy-five (75) minutes of direct contact with the patient. This time is exclusive of time spent rendering any other separately billable intervention to the patient. This service must satisfy all the elements of a consultation as defined in the Schedule of Benefits (see ).
When to Use
- Use for complex, non-emergency inpatient cases requiring a comprehensive review of multi-system infections or multi-drug resistant organisms where the direct patient contact time meets or exceeds 75 minutes.
- Use when a formal written request is received from a referring physician or nurse practitioner for a comprehensive evaluation that cannot be addressed within the scope of a standard assessment code like A460.
Common Pitfalls
- Failing to document exact start and stop times in the patient's chart, which leads to an automatic adjustment to a lower-paying assessment fee during audit.
- Billing C460 when the service was requested by a medical trainee, as this violates the requirement for a formal request from a licensed practitioner and triggers a payment reduction.
- Including time spent on separately billable procedures or interventions in the 75-minute calculation, which is strictly prohibited by the Schedule of Benefits.
Billing Tips
- Ensure the written consultation report is sent to the referring practitioner promptly, as the absence of this documentation is a primary trigger for fee clawbacks.
- If the patient is a trauma case with an ISS score meeting the criteria, remember to append the E420 premium to the C460 claim to maximize the return on high-acuity work.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
The start and stop times must be recorded in the patient's permanent medical record.
A copy of the written request for the consultation 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 written 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 report of the consultation findings, opinions, and recommendations must be provided to the referring practitioner.
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