C565 – Limited paediatric consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A limited consultation is an assessment 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, as defined in through . It is rendered by a Paediatric specialist following a written request from a referring physician, nurse practitioner, or dental surgeon for an expert opinion on a non-emergency hospital in-patient. The 'C' prefix designates this service for acute care hospital non-emergency in-patient services, as per .
When to Use
- Use C565 for a focused, non-emergency inpatient assessment requested by a referring physician when the clinical complexity does not warrant the full C562 consultation.
- Select C565 when providing a second opinion on a specific, narrow clinical question for an inpatient where a comprehensive multisystem review is not required.
Common Pitfalls
- Billing C565 without a formal, written referral request in the chart will result in a rejection or a reduction to a lower-valued assessment code upon audit.
- Using C565 for a patient already under your active care for the same condition is inappropriate; consultations are intended for new episodes or distinct clinical problems requiring an expert opinion.
- Failing to include the referring provider's name and billing number in the consultation report is a common cause for claim rejection.
Billing Tips
- Ensure your documentation explicitly states the 'limited' nature of the consultation to justify why C565 was billed instead of the higher-valued C562.
- Always apply the appropriate age premium (e.g., for patients under 16) to the C565 base fee to ensure you are capturing the full value of the service.
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 physician, nurse practitioner or dental surgeon must be kept in the consulting physician's medical record. In a hospital, the written request may be contained on the common medical record.
The request must identify the consultant by name, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identify the patient by name and health number.
The written request sets out the information relevant to the referral and specifies the service(s) required.
The consultant must prepare a written report including findings, opinions, and recommendations to the referring physician, nurse practitioner or dental surgeon.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.