C545 – Limited consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation is an assessment rendered following a written request from a referring: 1. physician 2. nurse practitioner or 3. dental surgeon in connection with an insured dental procedure rendered in a hospital, who, in light of his/her professional knowledge of the patient, requests the opinion of a physician (the "consultant physician”) competent to give advice in this field because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient or patient's representative. A consultation includes the services necessary to enable the consultant to prepare a written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner or dental surgeon. Except where otherwise specified, the consultant is required to perform a general, specific or medical specific assessment, including a review of all relevant data. As a 'C' prefix code, this service is for non-emergency in-patient services in an acute care hospital as per .
When to Use
- Use C545 for a non-emergency in-patient assessment when a specific, focused opinion is requested by a referring practitioner for a patient already admitted to an acute care hospital.
- Use this code when the complexity or obscurity of a patient's condition requires a specialist's expertise, provided the referral is documented in writing before the service is rendered.
Common Pitfalls
- Billing C545 when the referral was requested by a medical trainee; this will be rejected or downgraded to a lesser assessment fee as only physicians, nurse practitioners, or dental surgeons can initiate a consultation.
- Failing to document the specific written request in the chart, which leads to automatic downgrading to a standard assessment fee during an audit.
- Billing a consultation for routine pre-operative assessments for low-risk elective procedures, which is often flagged as medically unnecessary.
Billing Tips
- Ensure the written referral identifies both the consultant and the referring practitioner by name and billing number to satisfy the mandatory documentation requirements for C-prefix codes.
- If you are providing a consultation in conjunction with a special visit premium, you must bill using an 'A' prefix assessment code instead of C545 to ensure the premium is processed correctly.
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 practitioner, 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.
A written report (including findings, opinions, and recommendations) must be prepared and sent to the referring practitioner.
'C' prefix codes apply to acute care hospital – non-emergency in-patient services.
Submit claim using an 'A' prefix assessment when an assessment is rendered in conjunction with a special visit premium.
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