C915 – 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 (see ). The 'C' prefix indicates the service is for a non-emergency hospital in-patient (see ). This service must follow all general rules for consultations, including the requirement for a written request from a referring practitioner.
When to Use
- Use C915 when a formal, written request for a consultation is received for a non-emergency hospital in-patient, but the clinical complexity or time required is significantly less than a full consultation (C015).
- Use this code for a secondary opinion or specific diagnostic advice on an in-patient where the referring practitioner requires a formal consultation report but the scope of the request is limited.
Common Pitfalls
- Billing C915 without a documented written request in the chart or common medical record, which is a mandatory requirement for all consultation codes.
- Attempting to bill C915 for ongoing management or follow-up care; once a consultation is completed, subsequent visits must be billed as subsequent hospital visits (e.g., C116), not as further consultations.
- Submitting C915 for a patient who is not an in-patient; the 'C' prefix strictly limits this to hospital in-patient settings, whereas 'A' prefix codes (e.g., A915) are for office or out-patient settings.
Billing Tips
- Ensure the referring practitioner's name and billing number are clearly documented in your consultation note to satisfy the audit requirement for the referral source.
- If the consultation is requested by a medical trainee, the fee will be automatically adjusted downward; ensure your documentation reflects the specific, limited nature of the request to support the 'limited' designation.
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, 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 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.
This service applies to non-emergency hospital in-patient services. See to .
For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable - see General Preamble to .
If the physician rendering the service requests a referring physician, nurse practitioner or dental surgeon to submit a consultation request for that service after the service has been provided, a consultation is not payable. The visit fee appropriate to the service rendered may be claimed.
Where a physician who has been paid for a consultation for the patient for the same diagnosis makes a request for a referral for ongoing management of the patient, the service rendered following the referral is not payable as a consultation, except as outlined in the Virtual Care Services section under definitions, part 3, commentary 3
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