C912 – Comprehensive family and general practice consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A comprehensive family and general practice consultation rendered to a non-emergency hospital in-patient. This service is subject to the same conditions as A912. As per , a consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon, due to the complexity, seriousness, or obscurity of the case. It requires the consultant to perform an assessment and provide a written report with findings, opinions, and recommendations to the referring practitioner. This specific consultation is intended for cases that are very complex, obscure, or serious.
When to Use
- Use C912 when a hospital in-patient requires a comprehensive assessment for a complex, multi-system, or obscure clinical presentation that necessitates a formal written referral from another physician or nurse practitioner.
- Use this code for a scheduled, non-emergency consultation where the patient's clinical complexity exceeds the scope of a standard C003 or C004 hospital visit.
Common Pitfalls
- Failing to record exact start and stop times in the chart, which triggers an automatic reduction to a lesser assessment fee because C912 is a time-based service.
- Billing C912 for a patient already under your care for the same condition, as a consultation requires a new request from a different practitioner for a distinct clinical problem.
- Attempting to claim Special Visit Premiums with C912, which is strictly prohibited; use 'A' prefix codes if the service is an emergency or a special visit.
Billing Tips
- Ensure the written referral request is physically or electronically present in the chart before billing, as the Ministry frequently audits the existence of the referring practitioner's signature.
- Always document the specific clinical complexity that justifies the consultation to support the 'complex, obscure, or serious' requirement if the claim is reviewed.
Effective: April 1, 2026
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 practitioner, must be kept in the medical record. The request must identify the consultant and referring practitioner by name, and the patient by name and health number, and specify the service(s) required (see ).
A written report including findings, opinions, and recommendations must be prepared and sent to the referring practitioner (see ).
As this service is time-based (subject to the conditions of A912), the start and stop times of the assessment must be recorded in the patient's permanent medical record. In the absence of such information, the service is payable as a lesser assessment.
Subject to the same conditions as A912.
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