C605 – Consultation - Cardiology
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation is an assessment rendered in an acute care hospital for a non-emergency in-patient following a written request from a referring physician, nurse practitioner, or dental surgeon (in connection with an insured dental procedure rendered in a hospital). The referring practitioner, in light of their professional knowledge of the patient, requests the opinion of a physician (the consultant) competent to give advice in the field due to the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient or their representative. This service includes all elements necessary to prepare a written report to the referring practitioner, including a review of relevant data and a comprehensive assessment. The 'C' prefix designates this service for non-emergency hospital in-patients. For a Cardiology specialist, this service requires a diagnostic code of 428.
When to Use
- Use C605 when a non-emergency hospitalized patient requires a cardiology opinion for heart failure management, provided the referring practitioner has submitted a formal written request.
- Use C605 for an inpatient cardiology assessment when the patient’s clinical status is complex or obscure, necessitating a specialist opinion rather than routine daily care.
- Use C605 when a patient or their representative specifically requests a cardiology consultation for an existing condition, provided the referring practitioner documents the request.
Common Pitfalls
- Submitting C605 without a documented written request from the referring practitioner will result in an automatic downgrade to a lower-paying assessment fee.
- Using C605 for patients under 17 years of age is prohibited; ensure age eligibility is met before billing this code.
- Failing to use the mandatory diagnostic code 428 will lead to claim rejection, as this is a specific requirement for the C605 cardiology consultation.
Billing Tips
- If you are seeing the patient in a CCU, remember to add C101 to your claim to capture the premium, as it is eligible for payment alongside C605.
- Ensure the written referral includes the referring practitioner's billing number and your name, as missing these details invalidates the consultation status during an audit.
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 practitioner, must be kept in the consulting physician's medical record (or on the common medical record in a hospital, long-term care institution or multi-specialty clinic).
The request must identify the consultant by name, the referring practitioner by name and billing number, and 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.
Patient age 17 years and older
See General Preamble 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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