A016 – Repeat Consultation
OHIP General Listings Code — Anaesthesia (01) · Schedule of Benefits
A repeat consultation is an additional consultation rendered by the same consultant, in respect of the same presenting problem, following care rendered to the patient by another physician in the interval following the initial consultation but preceding the repeat consultation.
When to Use
- Bill A016 when a patient is referred back to you for the same presenting problem after seeing another physician (e.g., GP) for interim management, and you have a new referral.
- Use A016 instead of A015 if you have previously seen the patient for the same issue, but a different physician provided care in the interval.
- A016 is appropriate when a new referral is received for a patient you previously consulted on for the same condition, and another physician has intervened since your last assessment.
Common Pitfalls
- Billing A015 when A016 is indicated because the patient has been seen by the same consultant for the same problem previously, but a new referral was received after another physician's intervention.
- Failing to obtain a new written request from the referring provider, which is mandatory for A016 and distinguishes it from a simple follow-up assessment.
- Submitting A016 when the interim care was provided by the same consultant; this scenario would not meet the criteria for A016 and may be adjusted to A013.
Billing Tips
- Ensure the new referral clearly states the patient was managed by another physician in the interval between your consultations for the same presenting problem.
- When billing virtually, always append the 'A' suffix (A016A) and confirm the consultation was conducted via video.
Effective: June 1, 2025
Consultations and Visits
Anaesthesia (01)
Specialist
Consultation
A new written request from a referring physician, nurse practitioner, or dental surgeon must be kept in the consulting physician’s medical record (or common medical record in hospital/LTC/multi-specialty clinic).
The request identifies the consultant by name and/or specialty, referring provider by name and billing number, and patient by name and health number.
The written request sets out relevant referral information and specifies service(s) required.
A written report (findings, opinions, and recommendations) must be provided to the referring provider (and patient's primary care provider if referral by NP).
The consultant must perform a general, specific, or medical specific assessment, including a review of all relevant data.
Eligible for age-based fee premiums for patients under 16 years of age.
Eligible for special visit premiums (travel, etc.) if criteria are met.
If requested by a Medical Trainee, the fee is adjusted to a lesser assessment fee.
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