C470 – Comprehensive respiratory disease consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A comprehensive respiratory disease consultation for a patient in a non-emergency hospital in-patient setting. This service is subject to the same conditions as A470. As per , a consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon, due to the complexity, seriousness, or obscurity of the case, or because a second opinion is requested. The service includes a review of all relevant data and a written report to the referring practitioner. This service is a consultation rendered by a specialist in respiratory disease who provides all the appropriate elements of a consultation and spends a minimum of 75 minutes in direct contact with the patient, exclusive of time spent rendering any other separately billable intervention to the patient.
When to Use
- Use C470 for a complex, non-emergency hospital inpatient respiratory assessment requiring at least 75 minutes of direct patient contact, such as managing a patient with multi-organ failure and severe acute respiratory distress syndrome.
- Use C470 when a formal written request is received for a second opinion on a patient with obscure interstitial lung disease where the diagnostic workup and patient counseling exceed the time threshold of a standard C475 assessment.
Common Pitfalls
- Failure to record exact start and stop times in the medical record will result in an automatic audit adjustment to a lower-paying assessment code.
- Including time spent reviewing imaging, lab results, or writing the consultation report in the 75-minute calculation is a violation of the 'direct contact' requirement and will lead to clawbacks.
- Billing C470 when the service is rendered in an emergency department setting; C470 is strictly for non-emergency hospital inpatients, whereas emergency consultations must use the appropriate A-prefix codes.
Billing Tips
- Ensure the consultation report is sent to the referring practitioner immediately, as the absence of this document is the most frequent cause of rejection during post-payment audits.
- If the 75-minute direct contact threshold is not met, do not attempt to bill C470; instead, bill the appropriate C475 or C476 code to avoid rejection for time-based non-compliance.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Hospital and Institutional Consultations and Assessments, Consultations
A written report, including findings, opinions, and recommendations, must be provided to the referring practitioner.
A copy of the written request for the consultation, signed by the referring practitioner, must be kept in the consulting physician's medical record. In a hospital with common medical records, the request may be on the common 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 request must set out the information relevant to the referral and specify the service(s) required.
The start and stop times must be recorded in the patient’s permanent medical record or the amount payable for the service will be adjusted to a lesser paying fee.
Subject to the same conditions as A470.
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