C911 – Special family and general practice consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A special family and general practice consultation performed for a non-emergency hospital in-patient. This service is subject to the same conditions as A911, which is a consultation rendered by a GP/FP physician who provides all the elements of a consultation and spends a minimum of 50 minutes in direct contact with the patient, exclusive of time spent rendering any other separately billable intervention to the patient.
When to Use
- Use C911 when you are requested by another physician to provide a comprehensive 50-minute consultation for a non-emergency hospital inpatient.
- Use C911 for complex inpatient assessments that require a formal written referral and exceed the time threshold of standard inpatient visits like C005.
Common Pitfalls
- Failing to document exact start and stop times in the chart, which triggers an automatic adjustment to a lower-paying assessment code.
- Billing C911 for a patient in the Emergency Department; 'C' prefix codes are strictly for non-emergency hospital inpatients, whereas 'A' prefix codes are required for ED or office settings.
- Attempting to claim C911 when the referral is not documented or when the service is a routine follow-up rather than a formal consultation.
Billing Tips
- Always record the start and stop times clearly in the progress note to ensure the full fee is paid and to protect against audit adjustments.
- Ensure the referring physician's name and billing number are explicitly noted in your consultation report to satisfy the mandatory referral documentation requirements.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
A copy of the written request for the consultation must be kept in the consulting physician's medical record, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.
The start and stop times of the assessment must be recorded on the patient’s permanent medical record or the amount payable for the service will be adjusted to a lesser paying fee.
The request identifies the consultant by name and/or the specialty being consulted, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.
The written request sets out the information relevant to the referral and specifies the service(s) required.
Subject to the same conditions as A911.
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