C935 – Special surgical consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A special surgical consultation is rendered when a surgeon provides all the appropriate elements of a regular consultation and is required to devote at least fifty minutes exclusively to the consultation with the patient. This code is used for non-emergency hospital in-patient services. The calculation of the 50-minute minimum excludes time devoted to any other service or procedure for which an amount is payable in addition to the consultation. See .
When to Use
- Use C935 for complex in-patient surgical consultations where the clinical workup, review of extensive records, and patient/family counseling require a minimum of 50 minutes of exclusive, face-to-face time.
- Use this code when the complexity of the surgical decision-making exceeds a standard consultation (A935) due to multi-system comorbidities or the need for extensive informed consent discussions in a hospital setting.
Common Pitfalls
- Failing to document the exact start and end times of the 50-minute period is the most common reason for audit recovery; simply stating 'spent 50 minutes' is insufficient.
- Billing C935 when the 50-minute window includes time spent on other billable procedures or concurrent services, which is strictly prohibited by the definition of 'exclusive' time.
- Submitting C935 for a routine pre-operative assessment for low-risk elective surgeries (e.g., carpal tunnel or cataract) without clear, documented evidence of medical necessity for the extended consultation time.
Billing Tips
- Ensure your chart note explicitly details the complexity of the case and the specific components of the 50-minute encounter to justify why a standard consultation code was insufficient.
- If the consultation is interrupted by other clinical duties, you must restart the clock or ensure the total cumulative exclusive time spent solely on the consultation reaches the 50-minute threshold.
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 physician, nurse practitioner, or dental surgeon must be kept in the consulting physician's medical record. In a hospital or other facility with a common medical record, the written request may be contained on the common record.
The written request must identify the consultant by name, the referring physician/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 is required to prepare a written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner, or dental surgeon.
As a time-based service, the physician must record on the patient's permanent medical record or chart the time when the insured service started and ended.
A special surgical consultation is rendered when a surgeon provides all the appropriate elements of a regular consultation and is required to devote at least fifty minutes exclusively to the consultation with the patient.
The calculation of the 50 minute minimum excludes time devoted to any other service or procedure for which an amount is payable in addition to the consultation.
Claims for special surgical consultations are to be submitted using either A935 or C935, as applicable.
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