C595 – Limited consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
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. A consultation is an assessment rendered to a non-emergency hospital in-patient following a written request from a referring physician, nurse practitioner, or dental surgeon (in connection with an insured dental procedure in a hospital). The consultant physician provides an opinion because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient. The service includes a review of all relevant data and the preparation of a written report with findings, opinions, and recommendations for the referring practitioner.
When to Use
- Use C595 for a focused, time-limited consultation for a non-emergency hospital inpatient where the clinical complexity does not warrant the full scope of a C590.
- Use this code when providing a secondary opinion on a specific, narrow clinical question for an inpatient, provided a formal written request from the referring practitioner is present.
Common Pitfalls
- Billing C595 without a documented, formal written request from the referring practitioner will result in a downgrade to a standard assessment fee upon audit.
- Attempting to bill C595 for a patient you have already provided a consultation for regarding the same diagnosis will lead to rejection, as this is considered ongoing management.
- Submitting C595 when the service was requested by a medical trainee rather than a physician, nurse practitioner, or dental surgeon will trigger an automatic reduction to a general assessment fee.
Billing Tips
- Ensure the written request specifically identifies both the consultant and the referring practitioner by name and billing number to satisfy the mandatory documentation requirements for C595.
- If the consultation is for a patient under 16 years of age, remember to append the appropriate age-based premium to maximize the claim value.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
The request identifies the consultant by name and/or the specialty being consulted, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.
See to for rules on Non-Emergency Hospital In-Patient Services.
For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable - see General Preamble to .
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