C930 – Uveitis and ocular inflammatory diseases consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered by an ophthalmologist for a hospital in-patient regarding uveitis and ocular inflammatory diseases. As a consultation, it must be initiated by a written request from a referring physician, nurse practitioner, or dental surgeon who, due to the complexity, seriousness, or obscurity of the case, seeks the opinion of a specialist. The service includes a comprehensive assessment of the patient, a review of all relevant data, and the preparation of a written report with findings, opinions, and recommendations for the referring practitioner. This service is explicitly subject to the same conditions as A930.
When to Use
- Use C930 for a formal inpatient consultation requested by a referring physician for a patient with complex uveitis or systemic inflammatory disease requiring specialized ocular investigation.
- Use this code when the patient has been admitted to the hospital and you are providing a comprehensive assessment, including fundus dilation and review of systemic inflammatory laboratory or imaging data.
Common Pitfalls
- Billing C930 when the request is made by a medical trainee; such services are automatically downgraded to a lesser assessment fee.
- Failing to document the specific written request from the referring practitioner, which is a mandatory audit requirement for all 'C' prefix consultations.
- Attempting to bill C930 when a special visit premium is applicable; you must use an 'A' prefix assessment code (e.g., A235) instead of the 'C' prefix to ensure the premium is paid.
Billing Tips
- Ensure your documentation explicitly includes the analysis of laboratory and ocular imaging studies, as these are specific clinical requirements for C930 that distinguish it from a standard inpatient assessment.
- If you are called to the hospital for an urgent assessment and the referral is verbal, ensure a written request is obtained and filed in the chart before billing to avoid rejection or audit clawbacks.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
A copy of the written request for the consultation, signed by the referring practitioner, must be kept in the consulting physician's medical record (unless in a setting with a common medical record where the request may be on the common record).
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.
The consultant must prepare a written report including findings, opinions, and recommendations to the referring practitioner.
Dilated examination of the fundus;
Analysis of laboratory testing, radiological and ocular imaging studies performed for investigation of the patient’s ocular inflammatory disease.
Subject to the same conditions as A930.
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