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C545
C545 – Limited consultation
OHIP Consultations and Visits 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 .
Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon
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.
Usage limits
OR([1, "24_months", "per_patient_per_physician", "For the same diagnosis. A second consultation is payable if rendered for a hospital in-patient or ED patient more than 12 but less than 24 months after the first."], [1, "12_months", "per_patient_per_physician", "For a clearly defined unrelated diagnosis."])
'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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