C590 – Comprehensive rheumatology consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A comprehensive rheumatology consultation for a non-emergency hospital in-patient, as designated by the 'C' prefix (see ). This service is subject to the same conditions as the non-hospital comprehensive rheumatology consultation, A590. As a consultation, it requires a written request from a referring practitioner and a written report must be sent back to them, as detailed on page .
When to Use
- Use C590 for an initial inpatient rheumatological assessment of a complex patient requiring at least 75 minutes of direct face-to-face time, provided there is a formal written referral.
- Select C590 over a standard hospital visit (C003) when the clinical complexity necessitates a comprehensive consultation report and the 75-minute threshold is met.
Common Pitfalls
- Failure to document exact start and stop times in the chart will trigger an automatic adjustment to a lower-paying assessment code.
- Including chart review, imaging analysis, or report writing time in the 75-minute calculation is a common audit error; only direct patient-facing time counts.
- Billing C590 for a patient seen by the same consultant within the previous 12 months without a new written referral and a new clinical problem will result in a rejection or reduction to a follow-up visit.
Billing Tips
- Ensure the referring physician's name and billing number are clearly documented in your consultation report to satisfy the mandatory referral requirements.
- If the 75-minute threshold is not met, bill a standard hospital assessment (C003) rather than attempting to claim C590, as the latter is strictly time-dependent.
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, or on the common medical record in a hospital setting.
The written 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.
A written report, including findings, opinions, and recommendations, must be prepared and sent to the referring practitioner.
For A590 (and thus C590), the start and stop times must be recorded in the patient’s permanent medical record or the amount payable for the service will be adjusted to a lesser paying fee.
Subject to the same conditions as A590.
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