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OHIP Billing Guide🩺 ServicePublished 2026
C580

C580 OHIP Billing Code: Comprehensive Laboratory Medicine Consultation

C580 covers comprehensive consultations by pathologists for in-depth analysis of laboratory results for hospital in-patients. Billed by pathologists focusing on complex or unclear cases.

For Ontario Physicians & Billing StaffOHIP Schedule of Benefits Reference342.25 CAD~3 min read

1What Is the C580 OHIP Code?

C580 is a billing code covering comprehensive laboratory medicine consultations conducted by pathologists. It involves detailed assessment and interpretation of hospital in-patients' lab results, often when results are abnormal or complex, and requires a thorough clinical evaluation.

Commonly utilized when biochemical, hematologic, or microbiologic aberrations detected in a hospital setting necessitate expert interpretation, this consultation aims to deliver insightful clinical judgments alongside laboratory data.

Despite its importance, C580 consultations can be missed if time documentation fails or if eligibility requirements such as written referrals are not stringent.

2Related Codes

CodeNameFrequencyDescription
A285ConsultationAs per circumstancesCovers consultations within general settings of laboratory medicine.
A286Limited consultationAs per circumstancesFor situations needing less comprehensive analysis or consultation.
A580Comprehensive internal medicine consultationAs per C580Applicable for non-hospital settings with an equivalent level of complexity.
A585Diagnostic consultationAs per circumstancesFor diagnostic opinions on referred laboratory specimens.

3Eligibility Requirements

A comprehensive laboratory medicine consultation (C580) must be rendered to a hospital in-patient in a non-emergency setting. Eligibility requires a written referral from a physician, nurse practitioner, or dental surgeon for a complex or obscure case. The consultation must lead to a comprehensive report back to the referrer, covering findings, opinions, and recommendations.

Consultations are limited to one per patient every two years for the same diagnosis but may increase to two if the second occurs in a hospital or ED setting between 12 and 24 months after the first. For unrelated diagnoses, one service every 12 months is payable. Services provided virtually must adhere to video-only formats.

4What Your Clinical Note Must Show

1Medical Record Documentation

Accurate time documentation and referral information must be provided.

  • Record start and stop times in patient's medical record.
  • Retain a copy of the written referral from a qualified referrer.
  • Ensure the consultation includes a written report of findings and recommendations.

5Weak vs. Strong Note Examples

The strong note succeeds by detailing the start and stop times, listing referral source, specific findings, and including a recommendation, while the weak note lacks these essential elements.

❌ Weak Note

Consultation performed for abnormal lab results. Discussed with Dr. Smith. Report sent.

✓ Strong Note

Comprehensive consultation for abnormal hematologic markers in in-patient, Mr. J. Doe. Consult requested by Dr. Smith due to elevated markers suggesting potential lymphoma.

Full workup performed including assessment of previous lab results, comprehensive patient history, and examination findings.

  • Start time: 09:00 AM, Stop time: 11:00 AM
  • Consultation request from Dr. Smith (Referring MD #123456)
  • Details of findings: Elevated WBC count; recommendation for follow-up oncology consult.

6Common Reasons This Code Is Missed

1
Insufficient Documentation
Time documentation or detailed referral letters are missing, making it non-compliant with billing requirements.
2
Consultation Limits Exceeded
Attempting to bill more frequently than allowed for the same patient's diagnosis without a new referral or unrelated diagnosis.
3
Lack of Referral
No valid referral letter meeting necessary criteria, which is a fundamental requirement.
4
Virtual Format Misuse
Consultation billed virtually over the phone when video format is mandated for virtual services.
5
Incorrect Interpretation of Eligibility
Misunderstanding which patient cases qualify, especially distinguishing between complex and routine results.
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8Frequently Asked Questions

How frequently can C580 be billed for the same patient diagnosis?
It can be billed once per two consecutive 12-month periods unless specific conditions for a second consultation are met.
Can consultations for different diagnoses be billed annually?
Yes, for clearly unrelated diagnoses, one service every 12 months is permissible.
For which type of laboratory results is a comprehensive consultation suited?
Cases with serious abnormalities like unexpected hematologic changes require C580 for proper investigation and integration with clinical findings.
Is a virtual consultation for C580 permissible over the phone?
No, virtual C580 consultations must be conducted via video format only.
How is a consultation prompted by a GP versus an ER referral differentiated?
ER referrals often follow acute findings needing timely expert interpretation, whereas GP referrals might emerge from ongoing result discrepancies.
What’s expected for documentation if the patient’s lab results necessitate further evaluation by oncology?
Detail elevated markers with a recommendation for oncology consultation to substantiate clinical judgment and derived actions.
What patient categories qualify for C580 consultations?
Typically, hospital in-patients with enigmatic or severe biochemical or microbiologic abnormalities once cleared by primary physician/nursing practitioner.
Why might a previous consultation limit not apply to another service today?
A fresh referral for a new, unrelated diagnosis resets eligibility for another consultation within the billing period.
Disclaimer: This article is intended as a general educational resource for physicians and billing staff. It does not constitute billing advice or a definitive interpretation of the OHIP Schedule of Benefits. Always verify current billing codes, eligibility criteria, and documentation requirements directly against the official Schedule of Benefits or consult with a qualified medical billing specialist.
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