C925 – Limited consultation - Occupational Medicine - Hospital In-Patient
OHIP Surgical Procedures Code · 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. It is rendered to a hospital in-patient by a specialist in Occupational Medicine.
When to Use
- Use C925 when providing a focused occupational medicine opinion on a hospitalized patient where the clinical complexity does not warrant the comprehensive scope of C720.
- Use this code for a follow-up consultation request that is clinically distinct from the initial admission assessment but does not meet the intensity requirements of a full C725 consultation.
Common Pitfalls
- Billing C925 when the referral request originated from a medical trainee, which results in an automatic fee adjustment to a lower assessment code.
- Failing to maintain a copy of the written referral request in the hospital chart, which is a mandatory audit requirement for all C-prefix consultations.
- Attempting to bill C925 on the same day as another assessment or consultation by the same physician for the same patient, which will trigger an automatic rejection.
Billing Tips
- Ensure the written report to the referring provider explicitly details the findings and recommendations to justify the 'consultation' status over a standard subsequent visit code.
- If called to the hospital from outside the facility for an emergency, ensure you append the appropriate C9xx series special visit premium to the C925 claim to capture the travel and service intensity.
Effective: April 1, 2026
Hospital In-Patient
Consultation
The consultant must provide a written report (including findings, opinions, and recommendations) to the referring provider.
The service must meet all the requirements of a consultation but is less demanding or time-consuming than a full consultation.
A copy of the signed written request must be kept in the medical record (or common hospital record).
If the requirements for a consultation (e.g., written request, report) are not met, the amount payable will be adjusted to a lesser assessment fee.
Consultations requested by a Medical Trainee are adjusted to a lesser assessment fee.
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