C645 – Consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This code represents a specialist surgical procedure under the General Thoracic Surgery specialty (<specialtyCode>64</specialtyCode>). The 'C' prefix designates this service is performed for a non-emergency in-patient of an acute care hospital, as defined on page . The fee for this service is for the surgeon's component (suffix A). Fees for surgical assistance (suffix B) and anaesthesia (suffix C) are calculated separately based on basic and time units outlined in the General Preamble. According to , a second assistant's service is payable without prior authorization for the related procedure `R645`, which may apply to C645.
When to Use
- Use C645 for the initial specialist consultation requested by a physician or nurse practitioner for an admitted, non-emergency in-patient in an acute care hospital.
- Use this code when providing a formal, written consultation report for a thoracic surgical opinion that does not meet the criteria for an emergency assessment code.
Common Pitfalls
- Billing C645 for patients in an emergency department setting, which is incorrect as the 'C' prefix is strictly for acute care hospital in-patients.
- Failing to document the referring physician or nurse practitioner's name, which is a mandatory requirement for all consultation codes.
- Attempting to bill C645 for follow-up visits; once the consultation is complete, subsequent visits must be billed as subsequent hospital visits (e.g., C002).
Billing Tips
- Ensure the consultation report is clearly dated and signed in the patient's medical record to support the claim in the event of an audit.
- If the consultation leads to a surgical procedure, ensure the surgical fee (R645) is billed separately, as C645 covers only the assessment and consultation service.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Surgical
Consultations, Hospital and Institutional Consultations and Assessments
A consultation report must be included in the patient's medical record.
If performed by a Medical Trainee, the record must identify the Supervising Physician and the Medical Trainee, and be signed by the Supervising Physician as per .
The 'C' prefix indicates this service is for an acute care hospital non-emergency in-patient.
The fee for this service is for the surgeon's component (suffix A). Fees for surgical assistance (suffix B) and anaesthesia (suffix C) are claimed separately using the appropriate suffix.
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