C585 – Diagnostic Consultation
OHIP Surgical Procedures Code — Laboratory Medicine (28) · Schedule of Benefits
A diagnostic laboratory medicine consultation for a non-emergency hospital in-patient, subject to the same conditions as A585. The service is rendered when tissue, slides, specimens, and/or laboratory results prepared in one licensed laboratory are referred to a laboratory medicine physician (specialist in Haematopathology, Neuropathology, Medical Biochemistry, Medical Microbiology, Anatomic and General Pathology) not in the same licensed laboratory for a written opinion. The specific elements are the same as for the L800 series of codes (see page to ).
When to Use
- Use C585 when providing a formal written pathology opinion on slides or tissue blocks originally processed at an external, non-affiliated laboratory for a hospital inpatient.
- Use this code for secondary expert review of complex microbiological or biochemical results that were generated by a different licensed laboratory facility.
Common Pitfalls
- Billing C585 when the specimens were processed in your own laboratory is a common audit trigger; use L-series codes instead for internal work.
- Submitting C585 without a formal, documented written opinion in the patient record will lead to recovery of funds during an audit.
- Attempting to bill additional laboratory service codes alongside C585 is prohibited, as the consultation fee is intended to be all-inclusive for the review.
Billing Tips
- Ensure the referral source (the requesting physician) is clearly documented in the consultation report to satisfy the mandatory referral requirement for C585.
- If the patient is under 16 years of age, remember to append the appropriate age premium percentage to the C585 base fee to maximize your claim.
Effective: June 1, 2025
Consultations and Visits
Laboratory Medicine (28)
Consultation
Hospital and Institutional Consultations and Assessments, Consultations
A written opinion must be provided.
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