C515 – Limited consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
`C515` is a limited consultation for a non-emergency hospital in-patient rendered by a specialist in Physical Medicine & Rehabilitation (31). A limited consultation, as defined on , is an assessment that is less demanding and typically requires substantially less physician time than a full consultation (e.g., C315). It must otherwise meet all the requirements for a consultation as outlined on , which includes: - A written request from a referring physician, nurse practitioner, or dental surgeon. - Proper identification of the patient, referring practitioner, and consultant. - A written report of findings, opinions, and recommendations sent back to the referring practitioner.
When to Use
- Use C515 when the referring physician requests a focused opinion on a specific physical medicine issue that does not require the comprehensive multi-system review necessitated by a full consultation like C315.
- Select C515 for follow-up assessments that meet the formal criteria for a consultation but are limited in scope, such as a specific functional evaluation for a patient already admitted to a non-emergency hospital setting.
Common Pitfalls
- Billing C515 when a written referral request is missing or not properly documented in the hospital chart, which will trigger a downgrade to a lower-paying assessment code upon audit.
- Attempting to bill C515 in conjunction with a special visit premium; if a premium is required, you must use the 'A' prefix code (A515) instead of the 'C' prefix.
- Submitting C515 for a patient seen by a medical trainee without the supervising specialist performing and documenting the required components of the consultation.
Billing Tips
- Ensure your written report explicitly states the findings and recommendations relevant to the specific referral question to justify the 'limited' consultation status over a standard assessment.
- If you provide psychotherapy or psychiatric care on the same day as C515, you must document distinct, unrelated diagnoses for both services to avoid automatic rejection of the second claim.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Hospital and Institutional Consultations and Assessments, Consultations
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.
The consultant must prepare a written report (including findings, opinions, and recommendations) to the referring practitioner.
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.
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