C715 – Consultation
OHIP Surgical Procedures Code — Critical Care Medicine (11) · Schedule of Benefits
A consultation is an assessment rendered by a specialist in Critical Care Medicine (11) following a written request from a referring physician, nurse practitioner, or dental surgeon. This service is for a non-emergency hospital in-patient and is requested due to the complexity, seriousness, or obscurity of the case, or because a second opinion is requested. The service includes all elements necessary for the consultant to prepare a written report with findings, opinions, and recommendations for the referring practitioner.
When to Use
- Use C715 for a non-emergency, scheduled in-patient assessment when a referring physician or nurse practitioner formally requests your specialized expertise for a complex or obscure clinical problem.
- Use this code when providing a second opinion for an in-patient whose management plan requires a formal consultation report to be sent back to the primary attending physician.
Common Pitfalls
- Billing C715 for emergency situations; if the patient requires an urgent or emergent assessment, you must use the 'A' prefix codes (e.g., A715) combined with the appropriate Special Visit Premium.
- Failing to document the written request or the formal report; missing either of these components will trigger a downgrade to a lower-paying assessment code upon audit.
- Attempting to claim C715 when the request originates from a medical trainee; consultations must be requested by a physician, nurse practitioner, or dental surgeon to be valid.
Billing Tips
- Ensure the written request in the hospital chart explicitly identifies both the referring practitioner's billing number and the consultant's name to meet strict documentation requirements.
- If the patient is in an ICU or CCU, remember to add the C101 premium to your claim, provided you are not already claiming a service that explicitly excludes it.
Effective: June 1, 2025
Consultations and Visits
Critical Care Medicine (11)
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
A copy of the written request for the consultation, signed by the referring practitioner, must be kept in the consulting physician's medical record. In a hospital where common medical records are maintained, the written request may be on the common record.
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.
A written report including findings, opinions, and recommendations must be prepared and sent to the referring practitioner.
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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