H065 – Consultation in Emergency Medicine
OHIP Obstetrics Code — CONSULTATIONS AND VISITS · Schedule of Benefits
An Emergency Room (ER) Physician Consultation is an assessment rendered by a physician working in an emergency department or hospital urgent care clinic following a written request from a referring physician, nurse practitioner, or dental surgeon. This service is claimed with H065 when rendered by any physician other than a specialist in emergency medicine (FRCP). The consultation is for cases where, due to complexity, seriousness, or obscurity, the referring provider requests the opinion of the ER physician. It includes all services necessary to prepare a written report of findings, opinions, and recommendations to the referring provider. An ER report can serve as adequate documentation if it contains all constituent elements and a copy is sent to the referring provider.
When to Use
- Use H065 when a non-FRCP physician in the ER provides a formal consultation requested by a primary care provider or NP for a complex case requiring a written report.
- Use H065 when the clinical complexity of a patient in the ER necessitates a formal opinion beyond a standard assessment, provided a written referral request is documented.
Common Pitfalls
- Billing H065 when the patient was not formally referred by a physician, NP, or dental surgeon, which will result in an automatic adjustment to a lower assessment fee.
- Failing to ensure the consultation report is sent to the referring provider, as this triggers a mandatory payment adjustment to a standard assessment fee.
- Attempting to claim special visit premiums (e.g., K963) alongside H065, which is strictly prohibited for 'H' prefix emergency department codes.
Billing Tips
- Ensure the referring provider's name and billing number are clearly documented in the chart to satisfy the consultation requirement and avoid audit downgrades.
- If you are an FRCP-certified emergency physician, use H055 instead of H065 to ensure correct fee schedule alignment.
Effective: April 1, 2026
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, 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.
ER reports constitute adequate documentation of the written report of the consultation as long as the rendering of all constituent elements is clearly documented on all copies of the report.
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