A086 – 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.
When to Use
- Bill A086 when a patient is referred back to you for the same presenting problem after seeing another physician for interval care, and you are providing a new assessment.
- Use A086 if the patient's condition has evolved or a new aspect of the original problem requires re-evaluation by you, following another physician's intervention.
- A086 is appropriate when a different physician manages the patient between your initial consultation (A085) and your subsequent assessment for the same core issue.
Common Pitfalls
- Billing A086 when the patient has not been seen by another physician in the interval; this should be billed as a standard consultation (A085) if criteria are met.
- Failing to obtain a new, valid referral for the repeat consultation; the original referral is insufficient for A086.
- Submitting A086 when the 'interval care' was provided by the same consultant; this scenario does not meet the definition of a repeat consultation.
Billing Tips
- Ensure the referral documentation clearly indicates the interval care provided by another physician and the reason for the repeat consultation.
- Retain a copy of the new referral request, even if the patient was seen in a hospital setting, unless common medical records are definitively maintained.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultation
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.
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.
The consultant is required to perform a general, specific or medical specific assessment, including a review of all relevant data.
A written report (including findings, opinions, and recommendations) must be sent to the referring physician, nurse practitioner or dental surgeon.
If the requirements for a repeat consultation are not met (e.g., no new written request or no interval care by another physician), the fee will be adjusted to a lesser assessment fee.
Eligible for age-based fee premiums for patients under 16 years of age (10% to 30% increase depending on age).
Eligible for Special Visit Premiums ( to ) when applicable for emergency or special calls.
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