1What Is the C045 OHIP Code?
What is C045?
The C045 billing code covers neurosurgical consultations for in-patients in non-emergency hospital settings in Ontario. It encompasses the initial assessment provided by a neurosurgeon upon referral for complex or unclear cases, such as subdural collections, spinal injuries, and hydrocephalus.
Neurosurgeons are often asked to perform consultations to guide treatment decisions or confirm diagnoses. This makes C045 critical in ensuring patients receive appropriate surgical evaluations. Failure to document the referring physician’s written request or the time taken for the consultation can lead to missed billing opportunities.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A935 | Special surgical consultation | As applicable in Neurosurgery listings | Higher fee for complex surgical consultations. |
| C935 | Special surgical consultation | As applicable in Neurosurgery listings | Higher fee for complex surgical consultations. |
| A045 | Consultation | Every two consecutive 12-month periods | All non-hospital-based equivalent consultations. |
| A046 | Repeat consultation | As needed within GP preamble limits | Lower fee for follow-up consultations. |
3Eligibility Requirements
Eligibility Requirements for C045
- Setting: Must be rendered in a non-emergency hospital in-patient setting.
- Referral: Must involve a written request from a referring physician, nurse practitioner, or dental surgeon. This request must identify the neurosurgeon, the referring individual by name and billing number, and the patient.
- Frequency: C045 is payable once every two consecutive 12-month periods for the same patient, physician, and diagnosis. A second service within this period is billable if rendered to a hospital inpatient or Emergency Department patient more than 12 but less than 24 months after the first.
- Virtual Delivery: Permitted via video, coded as C045A.
Excess services are billed at the general or specific assessment rate.
4What Your Clinical Note Must Show
Keeping precise records ensures compliance with billing regulations.
- Written request from the referring source documenting need and specifics of consultation.
- Time of service start and end recorded on the patient's permanent medical record.
- Consulting neurosurgeon's findings, opinions, and recommendations must be documented in a written report to referrer.
5Weak vs. Strong Note Examples
The strong note succeeds as it includes all necessary referral details, a description of the complexity, and the duration of consultation, while the weak note lacks sufficient specifics and documentation.
Consultation performed for patient with back pain. Discussed with team.
Consultation performed upon written referral from Dr. Smith. Patient has complex lumbar spinal injury with suspected nerve impingement. After thorough examination and review of imaging, recommend surgical intervention. Time spent: 09:00 to 10:00.
- Includes referring physician's details.
- Clear indication of complex case assessment.
- Documented time spent.
