C615 – Consultation
OHIP Surgical Procedures Code — Haematology (61) · Schedule of Benefits
This service is a consultation for a non-emergency acute care hospital in-patient (, ). A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon for their opinion on a complex, serious, or obscure case (). The service includes a full history of the presenting complaint, a detailed examination of relevant parts or systems to establish a diagnosis, and providing a written report with findings and recommendations to the referring practitioner. It also includes all common elements of insured services (, ) and specific elements of assessments ().
When to Use
- Use C615 for a formal request from a referring physician to provide a specialist opinion on a complex haematological condition for an in-patient aged 17 or older.
- Use C615 when you are assuming responsibility for a specific diagnostic or therapeutic opinion on a patient already admitted to hospital under another service, provided a written request exists.
Common Pitfalls
- Billing C615 when the request originates from a medical trainee (resident or fellow) rather than a staff physician, nurse practitioner, or dental surgeon, which will trigger a downgrade to an assessment fee.
- Failing to document the referring physician's name and billing number in the medical record, which is a mandatory requirement for the consultation fee to be upheld during an audit.
- Billing C615 for a patient aged 16 or under; you must use C765 for paediatric haematology consultations instead.
Billing Tips
- Ensure your written report is sent to the referring practitioner promptly, as the absence of a formal report documenting your findings and recommendations invalidates the consultation claim.
- If you are called to the hospital urgently for a haematology consultation, do not use C615; use the appropriate 'A' prefix code (A615) combined with the applicable Special Visit Premium (Table III) to ensure proper compensation.
Effective: June 1, 2025
Consultations and Visits
Haematology (61)
Consultation
Hospital and Institutional Consultations and Assessments, Consultations
A copy of the written request for 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 referring physician, nurse practitioner or dental surgeon 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 ().
The consultant must prepare a written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner or dental surgeon ().
Applicable to patients 17 years of age and older. For patients 16 years of age and under, see C765.
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