C725 – Occupational medicine consultation - hospital in-patient
OHIP Surgical Procedures Code · Schedule of Benefits
A consultation rendered to a hospital in-patient by a specialist in occupational medicine following a written request from a referring physician, nurse practitioner, or dental surgeon. The service includes the necessary assessment and a written report to the referring provider.
When to Use
- Use C725 when a hospital in-patient is referred to you for an occupational medicine opinion regarding workplace exposure or injury, provided there is a formal written request from the MRP.
- Use this code for the initial in-patient assessment when the clinical complexity does not meet the 75-minute threshold required for the higher-valued C720.
Common Pitfalls
- Submitting C725 when the referral request originated from a medical trainee, which will result in a downgrade to a lesser assessment fee.
- Billing C725 when you are the admitting physician; in this scenario, the service is considered an admission assessment rather than a consultation.
- Failing to ensure the written request is physically present in the patient's hospital chart, as this is the primary documentation requirement for audit compliance.
Billing Tips
- If you are called to the hospital on a non-elective basis, ensure you append the appropriate C96x travel and C99x/C98x first-person-seen premiums to maximize the claim value.
- If the patient has been seen by you for the same condition within the last 90 days, bill a re-assessment code instead of C725 to avoid rejection.
Effective: April 1, 2026
Hospital In-Patient Service
Consultation
A written request from a referring physician, nurse practitioner, or dental surgeon (for hospital-based dental procedures) is mandatory.
The consultant must provide a written report (findings, opinions, and recommendations) to the referring provider.
The request must identify the consultant, the referring provider (name and billing number), and the patient (name and health number).
The request must be kept in the patient's medical record (or common hospital record).
The consultant must perform a general, specific, or medical specific assessment.
The written request sets out the information relevant to the referral and specifies the service(s) required.
If the physician has previously assessed the patient for the same illness within 90 days of admission, the admission assessment may be adjusted to a re-assessment fee.
Consultations requested by Medical Trainees are adjusted to a lesser assessment fee.
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