A036 – Repeat Consultation
OHIP General Listings Code — General Surgery (03) · 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 A036 when a patient returns to your care for the same presenting problem after seeing another physician (e.g., a GP managing a post-operative complication) and you receive a new referral.
- Use A036 if you initially consulted on a complex surgical issue, the patient was managed by another specialist for a related but distinct aspect, and now requires your re-evaluation for the original problem with a new referral.
- A036 is appropriate if the patient was discharged from your care after an initial consultation, saw another physician for a different condition, and then requires a follow-up consultation for the original presenting problem with a new referral.
Common Pitfalls
- Billing A036 without a new, valid referral from a physician, NP, or dental surgeon will result in rejection or adjustment to A033.
- Failure to document that another physician provided care to the patient between your initial and repeat consultation is a common audit risk.
- Using A036 when the patient has not seen another physician in the interval, or if the repeat consultation is for a new presenting problem, will lead to incorrect billing.
Billing Tips
- Ensure the new referral for A036 clearly states the original presenting problem and the reason for the repeat consultation.
- Retain a copy of the referral letter in the patient's chart, noting the name and OHIP billing number of the referring provider, unless it's a common record system.
Effective: June 1, 2025
Consultations and Visits
General Surgery (03)
Professional Fee
Consultation
Must be rendered by the same consultant who performed the initial consultation.
Must be for the same presenting problem as the initial consultation.
Requires a new written request from a referring physician, nurse practitioner, or dental surgeon.
Care must have been rendered to the patient by another physician in the interval between the initial and repeat consultation.
Includes the services necessary to prepare a written report (findings, opinions, and recommendations) to the referring provider.
Consultant must perform a general, specific, or medical specific assessment.
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.
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