C835 – Comprehensive nuclear medicine consultation
OHIP Surgical Procedures Code — NUCLEAR MEDICINE (63) · Schedule of Benefits
Provides for a comprehensive consultation by a specialist in Nuclear Medicine for a non-emergency in-patient in an acute care hospital. As a consultation, it requires a written request from a referring practitioner due to the complexity, seriousness, or obscurity of the case. The service must include all the constituent elements of a consultation as defined in the Schedule of Benefits, including a review of relevant data and a written report to the referring practitioner. This service is specifically noted as being 'subject to the same conditions of A835'.
When to Use
- Use C835 for a formal, requested in-patient consultation regarding complex nuclear medicine diagnostic interpretation or therapeutic planning that requires a comprehensive review of the patient's clinical history.
- Use this code when the referring physician specifically requests your expert opinion on a complex case, rather than a routine diagnostic test interpretation, to address diagnostic obscurity or treatment management.
Common Pitfalls
- Failing to maintain a formal, written request from the referring physician in the hospital chart is the most common reason for audit recovery; a verbal request or a simple order for a scan does not satisfy the consultation requirement.
- Billing C835 for routine diagnostic interpretations that lack the comprehensive clinical assessment, opinion, and formal written report required by the Schedule of Benefits will lead to claim rejection or downgrading to a lower-value assessment code.
- Attempting to bill C835 on the same day as a routine visit or other assessment for the same patient without clearly distinct clinical indications and documentation will trigger payment restrictions.
Billing Tips
- Ensure your documentation explicitly includes the start and stop times of the consultation, as this is a mandatory requirement for all hospital-based consultation codes.
- Always link the C835 claim to the specific written referral request in your records to ensure you can substantiate the 'consultation' status during a Ministry audit.
Effective: June 1, 2025
A. Consultations and Visits
NUCLEAR MEDICINE (63)
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 if in a hospital).
The request must identify the consultant, the referring practitioner by name and billing number, and the patient by name and health number.
The 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 practitioner.
The start and stop times of the service must be recorded in the patient’s permanent medical record.
Comprehensive nuclear medicine consultation - subject to the same conditions of A835
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