A076 – Repeat consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · 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. A repeat consultation has the same requirements as a consultation including the requirement for a new written request by the referring physician, nurse practitioner or dental surgeon. General Consultation Requirements As per , a consultation is an assessment rendered following a written request from a referring practitioner who requests the opinion of a consultant physician because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested. The service includes the services necessary to enable the consultant to prepare a written report to the referring practitioner. The consultant is required to perform a general, specific or medical specific assessment, including a review of all relevant data. This service includes the common elements of all insured services as described in and , and the specific elements of assessments as described in .
When to Use
- Bill A076 when a patient returns for a follow-up assessment on the same presenting problem, after seeing another physician for a distinct issue in the interim.
- Use A076 if the initial consultation (A075) was performed by you, and the patient subsequently saw another physician for a different condition, requiring your further opinion on the original problem.
- A076 is appropriate when a new written request is obtained for the same presenting problem, specifically after the patient has received care from another physician since your initial consultation.
Common Pitfalls
- Billing A076 without a new written request from the referring practitioner, even if the presenting problem is the same.
- Failing to document that the patient received care from another physician between the initial consultation and the repeat consultation, as required by the A076 definition.
- Using A076 when the patient has not seen another physician in the interval, or if the presenting problem has changed significantly, which would necessitate a new initial consultation code (e.g., A075).
Billing Tips
- Ensure the new written request for A076 clearly states the patient saw another physician in the interim and reiterates the need for your consultation on the original presenting problem.
- Remember that the standard consultation limits (e.g., per 12 or 24 months) do not apply to A076, allowing for medically necessary repeat consultations under the specified conditions.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations
A copy of the new written request for the repeat consultation, signed by the referring physician, nurse practitioner, or dental surgeon, must be kept in the consulting physician's medical record. For services in hospitals, long-term care institutions, or multi-specialty clinics with common records, the request may be on the common record.
The request must identify the consultant by name, the referring practitioner by name and billing number, and the patient by name and health number.
The written request must set out the information relevant to the referral and specify the service(s) required.
A written report including findings, opinions, and recommendations must be prepared and sent to the referring practitioner.
The standard limits on the number of consultations per 12 or 24 month period do not apply to repeat consultations ().
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.