1What Is the C545 OHIP Code?
C545 covers a limited gastroenterology consultation for non-emergency hospital in-patients. This service is typically used to provide a concise expert opinion on a specific issue like the timing of an endoscopy or managing anticoagulation, rather than a comprehensive assessment.
Such consultations still require a formal referral following OHIP criteria but are less demanding on physician time than a full consultation. This convenience is ideal when the clinical scenario requires a focused, expert perspective.
Given its specific requirements and limitations, it's important to distinguish when C545 is appropriate to avoid misunderstandings in coverage and to support accurate billing.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A415 | Consultation | as needed within category limits | A comprehensive gastroenterology consultation. |
| A416 | Repeat consultation | when justified by patient status or time elapsed | A follow-up gastroenterology consultation. |
| A545 | Limited consultation | equivalent to C545 for out-patient settings | An out-patient limited gastroenterology consultation. |
| C415 | Consultation | as needed within category limits | A comprehensive in-patient gastroenterology consultation. |
3Eligibility Requirements
C545 is eligible for non-emergency hospital in-patient services under the Gastroenterology listing. It must be rendered following a written request from a referring physician, nurse practitioner, or dental surgeon for a specific insured procedure. Claims should use diagnostic codes 263, 555, 556, 571, or 579.
C545 is categorized as a limited consultation, subject to frequency limits: one service for the same patient, physician, and diagnosis every two years, or annually if the diagnosis is clearly different. The service can be rendered virtually, billed as C545A, but only via video and not by telephone.
4What Your Clinical Note Must Show
The consultation must be initiated by a written request.
- Referring physician’s details
- Nature of the referral
- Patient's relevant medical history
Ensure the claim includes one of the approved diagnostic codes.
- 263: Intestinal malabsorption
- 555: Regional enteritis
- 556: Ulcerative colitis
- 571: Chronic liver disease and cirrhosis
- 579: Other disorders of intestine
Limited to non-emergency hospital in-patient settings.
- Document patient inpatient status
- Ensure non-emergency nature is clear
5Weak vs. Strong Note Examples
The strong note succeeds by clearly documenting the referral details, specific clinical question, and the recommendation, adhering to OHIP requirements. The weak note lacks specificity and fails to outline the consultation's scope.
Patient seen for consultation.
Requested endoscopy timing advice.
Consultation completed upon the written request from Dr. White regarding patient Jane Doe, aiming to determine the timing for endoscopic evaluation and management of anticoagulation around procedure scheduling.
- Referral request received on [date]
- Specific clinical question addressed: timing of endoscopy
- Recommendation provided: proceed with endoscopy on [date], adjust anticoagulation as noted
