C575 – Limited 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 a full consultation. It is rendered to a non-emergency hospital in-patient by a specialist in Respiratory Disease. Otherwise, a limited consultation has the same requirements as a full consultation, which is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon. The consultation is requested because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient or patient's representative. It includes the services necessary to prepare a written report to the referring practitioner. The 'C' prefix specifically designates this service for non-emergency in-patient care in an acute care hospital.
When to Use
- Use C575 when a respiratory specialist provides a focused, time-limited assessment for an inpatient that does not require the depth of a full consultation (C570).
- Use C575 for a second opinion or specialized assessment on an inpatient where the clinical complexity is present but the time required is significantly less than a full consultation.
Common Pitfalls
- Billing C575 without a formal written request from the referring practitioner, which will lead to a clawback during an audit.
- Attempting to bill C575 when the referral was requested by the specialist after the service was already performed, which is strictly prohibited.
- Confusing C575 with a subsequent visit (C070) when the clinical work does not meet the formal criteria of a consultation.
Billing Tips
- Ensure the written referral specifically mentions the need for a consultation to address the complexity or obscurity of the case to justify the 'Limited' designation over a standard visit.
- If the patient is in an ICU or CCU, remember to append the C101 premium to C575 to maximize the claim value.
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 request must identify the referring physician, nurse practitioner, or dental surgeon by name and billing number.
The request must identify 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 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.
Under the heading of “Family Practice & Practice in General", a limited consultation is the service rendered by any physician who is not a specialist, where the service meets all the requirements for a consultation but, because of the nature of the referral, only those services which constitute a specific assessment are rendered.
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