C845 – Limited consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A limited consultation is a consultation which is less demanding and, in terms of time, normally requires substantially less of the physician's time than the full consultation. Otherwise, a limited consultation has the same requirements as a full consultation as defined on page of the Schedule. This service is for a non-emergency hospital in-patient, as indicated by the 'C' prefix. A consultation is an assessment rendered following a written request from a referring practitioner who requests the opinion of a specialist because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested. The consultant must provide a written report of findings, opinions, and recommendations to the referring practitioner, as per rules on page .
When to Use
- Use C845 for a focused, non-emergency inpatient assessment where the clinical complexity does not warrant the time or depth of a full consultation (C445).
- Use this code when you are providing a second opinion on a specific, limited clinical question for an inpatient, provided a formal written request is on the chart.
Common Pitfalls
- Billing C845 without a formal written request from the referring practitioner will result in a downgrade to a subsequent visit fee (C002) upon audit.
- Failing to document a formal written report to the referring practitioner is a primary cause for payment adjustment to a lesser assessment fee.
- Attempting to bill C845 when the referral was initiated by a medical trainee or resident will lead to an automatic rejection or downgrade, as these are not recognized referring practitioners.
Billing Tips
- Ensure the referring physician's name and billing number are explicitly recorded in your clinical notes to satisfy the documentation requirement for the referral.
- If you are seeing a patient transferred from another service, confirm that no other specialist has already claimed a consultation (C445 or C845) for that specific admission to avoid an automatic downgrade.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Hospital and Institutional Consultations and Assessments, Consultations
A copy of the written request for the consultation, signed by the referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician's medical record. In a hospital, the written request may be contained on the common medical record.
The consultant must prepare a written report including findings, opinions, and recommendations to the referring physician, nurse practitioner or dental surgeon.
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.
See General Preamble to . 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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